The approach to ovarian cancer in older women
- William P Tew, MD
William P Tew, MD
- Associate Member
- Memorial Sloan Kettering Cancer Center
- Associate Professor of Medicine
- Weill Medical College of Cornell University
- New York Presbyterian Hospital
- Kathleen M Moore, MD
Kathleen M Moore, MD
- Associate Professor
- Division of Gyn Oncology
- Mai Eager Anderson Chair of Cancer Clinical Trials
- Stephenson Cancer Center
- Universitiy of Oklahoma HSC
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
Cancer is recognized as a disease of older adults, with over 50 percent of new cases being diagnosed after age 65, and over 70 percent of deaths from cancer occurring in this same age group [1,2]. Ovarian cancer is the seventh most common cancer in women worldwide and accounts for nearly 4 percent of all new cases of cancer in women . It is also the eighth most common cause of cancer death in the world. The risk of ovarian cancer increased with age with only 10 to 15 percent of cases diagnosed before menopause . With increasing age, there is an increased prevalence of comorbid conditions, polypharmacy, functional dependence, cognitive impairment, depression, frailty, poor nutrition, and limited social support . Given these many potential limitations, it is not surprising that many older adult patients who present with advanced ovarian cancer receive less aggressive therapies than their younger counterparts and have poorer disease-specific outcomes. Because there are limited data on the approach to older women with gynecologic cancer in general, this topic will specifically discuss the care of the older woman with ovarian cancer.
Other topics related to the cancer care of this population are discussed separately. (See "Comprehensive geriatric assessment for patients with cancer" and "Treatment of metastatic breast cancer in older women" and "Drug prescribing for older adults" and "Hospital management of older adults" and "Systemic chemotherapy for cancer in elderly persons" and "Adjuvant therapy for resected colon cancer in elderly patients" and "Therapy for metastatic colorectal cancer in elderly patients and those with a poor performance status" and "Palliative care: Issues specific to geriatric patients".)
OVERVIEW OF THE APPROACH
Older patients should undergo a geriatric assessment (GA) at their initial presentation to determine whether or not they are appropriate candidates for cytoreductive surgery (CRS). (See 'Geriatric assessment' below.)
The results of the assessment can be used to determine the most appropriate treatment strategy:
●Patients who are candidates for CRS should proceed with primary surgical therapy. (See 'Approach to surgery' below.)
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- OVERVIEW OF THE APPROACH
- GERIATRIC ASSESSMENT
- Preoperative assessment
- - Preoperative Assessment of Cancer in the Elderly (PACE)
- - Frailty assessment
- - Comprehensive Geriatric Assessment (CGA)
- Prior to systemic therapy
- - Modified CGAs
- - Geriatric Vulnerability Score
- APPROACH TO SURGERY
- Primary cytoreductive surgery
- - Hazards of hospitalization
- - Postoperative death
- - Postoperative morbidity
- - Non-traditional discharge
- - Effect on chemotherapy delivery
- Interval cytoreductive surgery
- APPROACH TO FIRST-LINE MEDICAL THERAPY
- Importance of dose-intensity
- Options in treatment using intravenous therapy
- - The EWOC studies
- - Weekly dosing
- - Reduced doses
- - Incorporation of other agents
- - Single-agent carboplatin
- - Gynecologic Oncology Group 273
- Intraperitoneal chemotherapy
- NEOADJUVANT CHEMOTHERAPY
- TREATMENT OF RECURRENT DISEASE
- PALLIATIVE CARE
- SUMMARY AND RECOMMENDATIONS