Ovarian cancer: patterns of care in Victoria during 1993-1995
Grossi, M.; Quinn, M.A.; Thursfield, V.J.; Francis, P.A.; Rome, R.M.; Planner, R.S.; Giles, G.G.
Medical Journal of Australia 177(1): 11-16
2002
ISSN/ISBN: 0025-729X PMID: 12088472 Document Number: 543708
Objective: To describe the management of and outcomes in patients with newly diagnosed ovarian cancer during 1993, 1994 and 1995 in Victoria. Design and setting: Retrospective cohort study conducted by surveying doctors involved in managing incident ovarian cancer cases identified from the population-based Victorian Cancer Registry. The survey was conducted in 1997 and the cohort was followed up until the end of 1999 to obtain at least four years of follow-up data on all patients. Patients: All women with invasive epithelial ovarian cancer diagnosed during 1993, 1994 and 1995. Main outcome measures: Reported management in terms of staging, treatment and survival. Results: Management details were obtained for 84.5% (562/665) of eligible patients. Median age at diagnosis was 66 years (range, 22-98 years). Surgery was the primary therapy in 77.2% of women (434/562). Only one in three women had adequate surgery, which was less likely to be performed by general gynaecologists and general surgeons than gynaecological oncologists (21.3% (35/164) v 13.3% (8/60) v 52% (105/202)). After surgery 78.6% of women (341/434) received chemotherapy, usually with platinum-based regimens. The overall five-year relative survival was 46% for women treated surgically; poor survival was related to increasing age, later tumour stage, presence of ascites, residual disease >2 cm and poorer histological differentiation of the tumour. Conclusions: For optimal care a preoperative carcinoma antigen (CA)-125 assay, chest x-ray and pelvic ultrasound should be performed, and early referral to a multi-disciplinary unit for definitive surgery is advised. Every effort should be made to adequately stage or debulk the tumour. Women with high-risk early-stage and advanced disease should be considered for platinum-based chemotherapy.