Ovarian cancer is the fourth most common cancer among women in France, and mainly affects the elderly. The primary objective of this study was to compare treatment of ovarian cancer according to age.
All patients with invasive cancer (n = 1151) diagnosed between 1997 and 2011 in the Herault Department of southern France were included. Demographic data (age, area of residence), cancer characteristics (stage, histology, grade) and treatment modality (type, period and location of treatment) were analysed. Univariate and multivariate logistic regression was used to compare treatment by age.
Ovarian cancer was less treated in elderly compared to younger patients, regardless of the type of treatment. This difference was more pronounced for chemotherapy, and was maximal for surgery followed by chemotherapy (odds ratio (OR) for surgery for patients aged >70 vs those aged <70 years = 0.47 [0.24–0.91], OR for chemotherapy, age >70 vs <70 = 0.30 [0.16–0.55] and OR for surgery plus chemotherapy, age >70 vs <70 = 0.14 [0.08–0.28]). This effect of age was independent of other variables, including stage and grade. The probability of receiving standard treatment, in accordance with recommendations, was reduced by 50 % in elderly patients compared to their younger counterparts. Overall and net survival of elderly patients with standard treatment was similar to those of younger patients treated outside standard treatment.
Elderly women with ovarian cancer were therapeutically disadvantaged compared to younger women. Further studies including co morbidities are necessary to refine these results and to improve therapeutic management of elderly patients with ovarian cancer.
The American Society of Clinical Oncology (ASCO) convened a subcommittee to develop recommendations on improving the evidence base for treating older adults with cancer in response to a critical need identified by the Institute of Medicine. Older adults experience the majority of cancer diagnoses and deaths and make up the majority of cancer survivors. Older adults are also the fastest growing segment of the US population. However, the evidence base for treating this population is sparse, because older adults are underrepresented in clinical trials, and trials designed specifically for older adults are rare. The result is that clinicians have less evidence on how to treat older adults, who represent the majority of patients with cancer. Clinicians and patients are forced to extrapolate from trials conducted in younger, healthier populations when developing treatment plans. This has created a dearth of knowledge regarding the risk of toxicity in the average older patient and about key end points of importance to older adults. ASCO makes five recommendations to improve evidence generation in this population:
(1) Use clinical trials to improve the evidence base for treating older adults with cancer,
(2) leverage research designs and infrastructure for generating evidence on older adults with cancer,
(3) increase US Food and Drug Administration authority to incentivize and require research involving older adults with cancer,
(4) increase clinicians’ recruitment of older adults with cancer to clinical trials,
(5) use journal policies to improve researchers’ reporting on the age distribution and health risk profiles of research participants.
Cancer affects people of all ages, but prevalence increases with age. A greater number of older people will therefore be diagnosed with cancer than in other age groups.
Older people have traditionally been neglected in clinical research but this has started to change. It is heartening that the European Cancer Congress (ECCO) being held this month in Vienna is placing emphasis on ‘oncogeriatrics’. However, I am not sure this term is appropriate. We need to give careful consideration to collective names for groups of patients, given the recent outcry about using the word ‘frailty’ because of its association with negative outcomes.
In research I have undertaken, many participants aged 65 and older criticised the phrase ‘older people’, which demonstrates the importance of seeking patients’ opinions from the outset.