Real-world ovarian cancer care and its survival impact on older adults: An observational study from the Australian National Gynae-Oncology Registry (NGOR)

Introduction

Women aged ≥70 years with ovarian cancer (OC) may experience variations in care compared to best practice guidelines, and their five-year survival is significantly lower compared to women aged <70 years. The National Gynae-Oncology Registry (NGOR) is Australia's first clinical quality registry (CQR) for gynaecological cancers, measuring patterns of care using 15 OC clinical quality indicators (CQIs) reflecting evidence-based practice. This study aimed to compare adherence to CQIs for older versus younger groups with newly diagnosed OC and evaluate differences in 5-year overall survival (OS).

Materials and Methods

This is a multi-centre, observational study utilizing NGOR data for women with newly diagnosed OC at participating sites (May 2017 to July 2022). Demographics, CQIs, and clinical variables were compared between women aged ≥70 years (older group) and those aged <70 years (younger group). Five-year OS was estimated.

Results

A total of 1628 women were eligible. Median OS was 3.37 years (95 % CI: 3.05–3.86 years) in the ≥70 group versus not reached in the younger group aged <70 (95 % CQI: 5.95 – n/a years). Compared to the younger group, older women less frequently received first-line platinum-taxane doublet chemotherapy (69.1 % vs 91.6 %, p < 0.001) and first-line chemotherapy with a platinum-taxane doublet plus bevacizumab (18.9 % vs 29.9 %, p = 0.02). Older women were less likely to achieve primary surgery with no macroscopic residue (46.4 % vs 60.8 %, p = 0.03) and had lower clinical trial enrolment (15.5 % vs 21.7 %, p = 0.005). After adjusting for ECOG Performance Status, histological sub-type, cancer stage, and treatment group, five-year OS remained significantly lower in the older women with an adjusted HR for death 1.50 (95 % CI: 1.27–1.76, p = 0.001).

Discussion

Significant differences in care were observed in older women with OC, notably in achieving complete primary surgical cytoreduction, utilization of standard chemotherapy regimens, and trial enrolment. Survival for older women remains significantly lower than for younger women after adjustment. These findings highlight specific areas for potential quality improvement in the care of older Australian women with OC.