LAUSR

Objectives: Treating elderly women with ovarian cancer presents the clinician with difficult management decisions due to potential increased morbidity and mortality during treatment. We evaluated all women with ovarian cancer diagnosed at age ≥80. We sought to identify the rationale of the treatment decisions made in this elderly cohort. We hypothesized that women diagnosed with ovarian cancer at ≥80 years are less likely to receive standard of care treatment (SOC). Methods: After institutional review board (IRB) approval, all women diagnosed with ovarian cancer at ≥80 years of age, who received treatment at our institution from January 2011 to September 2018 were eligible for inclusion. Data collected included functional status, initial presentation, stage, treatment course, and demographics. Attention was paid to the rationale behind treatment decisions which deviated from SOC. These deviations were as follows: Patient goals of care; patient comorbidities; a combination of goals of care and comorbidities; or other. Deviation from SOC was classified as one of the following: Treatment declined, surgery related (inadequate, not recommended, or declined), adjuvant therapy not completed, other, and two or more. Statistical analysis was performed utilizing Wilcoxon rank sum test, Chi-square, and Kruskal-Wallis tests. Results: 61 patients met criteria for inclusion. 52% were age 80-84, 38% were age 85-89, and 10% were 90 years or older. Only 9.8% of all the patients (n=6) received SOC. Patients age 80-84 were more likely to receive SOC than patients age 85-89 and 90+ (p=0.049). 16% of our elderly cohort received NACT, compared to 18% of women with ovarian cancer at all ages who are treated at our institution. There were no women above the age of 85 (n=29) who received SOC for their pathologic diagnosis and stage of disease. The way in which treatment deviated from SOC did not vary by age group. However, the justification underlying treatment decisions deviating from SOC did vary significantly by age group: Individuals ≥90 were likely to receive alternate treatment due to co-existing comorbidities, while the goals of care were a significant factor in decisions made by women 85-89 (p=0.01). Overall survival did not differ significantly between the age groups (p=0.25). Conclusions: Women diagnosed with ovarian cancer at or above the age of 85 did not receive SOC compared with younger women. 16% of all elderly women chose NACT. Co-existing patient comorbidities were the primary reasons for deviation from SOC in patients 90 and above. The patients’ own management decisions played a significant role in women age 85-89.