Risk factors for early death among ovarian cancer patients: a nationwide cohort study

다국어 초록 (Multilingual Abstract)

Objective: To characterize ovarian cancer patients who die within 6 months of diagnosis and to identify prognostic factors for these early deaths.
Methods: A nationwide cohort study covering ovarian cancer in Denmark in 2005–2016. Tumor and patient characteristics including comorbidity and socioeconomic factors were obtained from the comprehensive Danish national registers.
Results: A total of 5,570 patients were included in the study. Three months after ovarian cancer diagnosis 456 (8.2%) had died and 664 (11.9%) died within 6 months of diagnosis. Adjusted for age and comorbidity, patients who died early were admitted to hospital significantly more often in a 6-month period before the diagnosis (odds ratio [OR]=1.61 [1.29–2.00], and OR=1.47 [1.21–1.78]), for patients who died within 3 and 6 months respectively). Low educational level (OR=2.11), low income (OR=2.50) and singlehood (OR=1.90) were factors significantly associated with higher risk of early death. The discriminative ability of risk factors in identifying early death was assessed by cross-validated area under the receiver operating characteristic curve (AUC). The AUC was found to be 0.91 (0.88–0.93) and 0.90 (0.87–0.92) for death within 3 and 6 months, respectively.
Conclusions: Despite several admissions to hospital, the ovarian cancer diagnosis is delayed for a subgroup of patients, who end up dying early, probably due to physical deterioration in the ineffective waiting time. Up to 90% of high-risk patients might be identified significantly earlier to improve the prognosis. The admittance of the patients having risk symptoms should include fast track investigation for ovarian cancer.

참고문헌 (Reference)

1 Engholm G, "Trends in the survival of patients diagnosed with cancer in the Nordic countries 1964–2003 followed up to the end of 2006" 49 : 545-560, 2010

2 Oken MM, "Toxicity and response criteria of the Eastern Cooperative Oncology Group" 5 : 649-655, 1982

3 Brewer KC, "The influence of neighborhood socioeconomic status and race on survival from ovarian cancer : a population-based analysis of Cook County, Illinois" 25 : 556-563, 2015

4 Gurney J, "The impact of patient comorbidity on cancer stage at diagnosis" 113 : 1375-1380, 2015

5 Peterson CE, "The effect of neighborhood disadvantage on the racial disparity in ovarian cancer-specific survival in a large hospital-based study in Cook County, Illinois" 3 : 8-, 2015

6 Engholm GF, "Storm NORDCAN-a Nordic tool for cancer information, planning, quality control and research" Association of the Nordic Cancer Registries

7 Maringe C, "Stage at diagnosis and ovarian cancer survival : evidence from the International Cancer Benchmarking Partnership" 127 : 75-82, 2012

8 Bristow RE, "Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status" 134 : 60-67, 2014

9 Robinson KM, "Socio-demographic factors, comorbidity and diagnostic delay among women diagnosed with cervical, endometrial or ovarian cancer" 20 : 653-661, 2011

10 Jørgensen TL, "Significance of age and comorbidity on treatment modality, treatment adherence, and prognosis in elderly ovarian cancer patients" 127 : 367-374, 2012

11 Nielsen N, "Risk of cancer and repeated urgent referral after negative investigation for cancer" 35 : 582-588, 2018

12 Chéreau E, "Ovarian cancer in the elderly : impact of surgery on morbidity and survival" 37 : 537-542, 2011

13 Cliby WA, "Ovarian cancer in the United States : contemporary patterns of care associated with improved survival" 136 : 11-17, 2015

14 Noer MC, "Ovarian cancer and comorbidity : is poor survival explained by choice of primary treatment or system delay?" 27 : 1123-1133, 2017

15 "Obesity: preventing and managing the global epidemic. Report of a WHO consultation" World Health Organ 1-253, 2000

16 Cowan RA, "Is it time to centralize ovarian cancer care in the United States?" 23 : 989-993, 2016

17 Long B, "Impact of race, socioeconomic status, and the health care system on the treatment of advanced-stage ovarian cancer in California" 212 : 468.e1-461, 2015

18 Berglund A, "Impact of comorbidity on management and mortality in women diagnosed with breast cancer" 135 : 281-289, 2012

19 Bristow RE, "Impact of National Cancer Institute Comprehensive Cancer Centers on ovarian cancer treatment and survival" 220 : 940-950, 2015

20 Terplan M, "Have racial disparities in ovarian cancer increased over time? An analysis of SEER data" 125 : 19-24, 2012

21 Cowan RA, "Exploring the impact of income and race on survival for women with advanced ovarian cancer undergoing primary debulking surgery at a high-volume center" 149 : 43-48, 2018

22 Janda M, "Elderly patients with stage III or IV ovarian cancer : should they receive standard care?" 18 : 896-907, 2008

23 Bristow RE, "Disparities in ovarian cancer care quality and survival according to race and socioeconomic status" 105 : 823-832, 2013

24 Fisher DA, "Determinants of medical system delay in the diagnosis of colorectal cancer within the Veteran Affairs Health System" 55 : 1434-1441, 2010

25 Sørensen SM, "Danish Gynecological Cancer Database" 8 : 485-490, 2016

26 Stairmand J, "Consideration of comorbidity in treatment decision making in multidisciplinary cancer team meetings : a systematic review" 26 : 1325-1332, 2015

27 Noer MC, "Confounders other than comorbidity explain survival differences in Danish and Swedish ovarian cancer patients-a comparative cohort study" 57 : 1100-1108, 2018

28 Walters S, "Comparability of stage data in cancer registries in six countries : lessons from the International Cancer Benchmarking Partnership" 132 : 676-685, 2013

29 Sperling C, "Comorbidity is an independent prognostic factor for the survival of ovarian cancer : a Danish register-based cohort study from a clinical database" 129 : 97-102, 2013

30 Ostenfeld EB, "Comorbidity and survival of Danish patients with colon and rectal cancer from 2000–2011 : a population-based cohort study" 5 : 65-74, 2013

31 Fagö-Olsen CL, "Centralized treatment of advanced stages of ovarian cancer improves survival : a nationwide Danish survey" 90 : 273-279, 2011

32 Coleman MP, "Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007(the International Cancer Benchmarking Partnership) : an analysis of population-based cancer registry data" 377 : 127-138, 2011

33 Huguet M, "Being treated in higher volume hospitals leads to longer progression-free survival for epithelial ovarian carcinoma patients in the Rhone-Alpes region of France" 18 : 3-, 2018

34 Danish Gynecological Cancer Database (DGCD), "Annual report" Danish Gynecological Cancer Group

35 Boll D, "Adherence to national guidelines for treatment and outcome of endometrial cancer stage I in relation to co-morbidity in southern Netherlands 1995–2008" 47 : 1504-1510, 2011

36 American Society of Anesthesiologists, "ASA physical status classification system" American Society of Anesthesiologists

37 Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation" 40 : 373-383, 1987

38 Noer MC, "A new clinically applicable age-specific comorbidity index for preoperative risk assessment of ovarian cancer patients" 141 : 471-478, 2016