Advanced epithelial ovarian cancer in older patients

Victoria Cullimore ¹, Kezia Gaitskell ², Rebecca Newhouse ³

¹Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK; Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
²Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, UK; Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
³Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK; Department of Gynaecological Oncology, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Coxford Road, Southampton, UK.
⁴Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK; Department of Obstetrics and Gynaecology, Manchester Academic Health Science Centre, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester, UK.
⁵Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane North, Fulwood, Preston, UK.
⁶Dept of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK.
⁷Pan Birmingham Gynaecological Cancer Centre, Birmingham, UK.
⁸Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Broomhall, UK.

⁰Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK; Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.

International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society +

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August 10, 2025

View abstract on PubMed

Summary

Older women with advanced ovarian cancer have similar survival to younger patients if they receive comparable treatment. Treatment disparities between UK cancer centers significantly impact outcomes for elderly patients.

Area Of Science

Oncology
Geriatric Medicine
Clinical Cancer Research

Background

Advanced epithelial ovarian cancer (EOC) management in older adults (≥75 years) requires careful consideration of age-related factors.
Outcomes for elderly EOC patients are influenced by treatment variations and comorbidities.

Purpose Of The Study

To analyze the management and survival outcomes of older patients (≥75 years) diagnosed with stage II or higher epithelial ovarian cancer.
To compare treatment patterns and survival between older (≥75) and younger (<75) patients across UK gynecological cancer centers.

Main Methods

Retrospective cohort study using the IMPRESS project data set (January 2018 - December 2019).
Inclusion of patients with epithelial ovarian cancer from 6 UK gynecological cancer centers.
Multivariate analysis comparing treatment and outcomes for patients aged ≥75 versus <75 years, accounting for variations between and within centers.

Main Results

Older patients (≥75) presented with poorer performance status and more comorbidities.
Significantly fewer older patients received combined surgery and chemotherapy (31.9% vs 64.6%, p < .0001).
After adjusting for treatment, the increased mortality risk for older patients diminished (RR 1.10), indicating treatment as a key factor, though survival varied by treatment group (p-heterogeneity = .0004).

Conclusions

Older women with epithelial ovarian cancer can achieve survival comparable to younger women when treated similarly.
Significant variations in treatment protocols exist between and within UK cancer centers, affecting older patients disproportionately.
Standardizing treatment approaches for elderly EOC patients across all centers is crucial to improve equitable outcomes.

Keywords:

Chemotherapy Cytoreductive Surgery Epithelial Ovarian Cancer Older Patients Primary Treatment

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