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Differences in Regional Diagnostic Strategies and in Intended Versus Actual First-Line Treatment of Patients With Advanced Ovarian Cancer in Denmark
  1. Carsten Lindberg Fagö-Olsen, MD, PhD*,
  2. Bent Ottesen, MD, DMSc*,
  3. Henrik Kehlet, MD, DMSc,
  4. Sofie Leisby Antonsen, MD, PhD*,
  5. Ib Jarle Christensen,
  6. Algirdas Markauskas, MD§,
  7. Berit Jul Mosgaard, MD, PhD*,,
  8. Christian Ottosen, MD*,
  9. Charlotte Hasselholt Sogaard, MD, PhD and
  10. Claus Hoegdall, MD, DMSc*
  1. *Department of Gynecology,
  2. Section of Surgical Pathophysiology;
  3. The Finsen Laboratory and Biotech Research and Innovation Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen;
  4. §Department of Gynecology and Obstetrics, Odense University Hospital, Odense;
  5. Department of Gynecology and Obstetrics, Herlev Hospital, Copenhagen University Hospital, Copenhagen; and
  6. Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
  1. Address correspondence and reprint requests to Carsten Lindberg Fagö-Olsen, MD, Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Section 7821Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E-mail: carstenlo{at}


Background Triage of patients with ovarian cancer to primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) is challenging. In Denmark, the use of NACT has increased, but substantial differences in the use of NACT or PDS exist among centers. We aimed to characterize the differences between intended and actual first-line treatments in addition to the differences in the triage process among the centers and to evaluate the different diagnostic modalities and the clinical aspects’ influence in the triage process.

Materials and Methods From 4 centers, forms containing data about the diagnostic process and intended treatment were prospectively collected and merged with data from the Danish Gynecological Cancer Database and medical records.

Results Of the 671 completed forms, 540 patients had stage IIIC or IV epithelial ovarian cancer. Of the 238 (44%) referred to PDS, 91% received PDS and 4% never had debulking surgery. Of the 288 patients (53%) referred to NACT, 44% were never debulked. Fourteen patients (3%) were referred to palliative treatment. The use of different imaging modalities, diagnostic laparoscopy, and laparotomy varied significantly among the centers. Diagnostic surgical procedures were considered to be most influential in the triage process. Regardless of the intended first-line treatment or center, the tumor size and dissemination was the most influential clinical aspect.

Conclusions In Denmark, substantial differences exist between intended and actual first-line treatments as well as in the diagnostic process and use of NACT, calling for further discussion on diagnostic strategy and therapeutically approach for patients with advanced ovarian cancer.

  • Ovarian cancer
  • Primary debulking surgery
  • Neoadjuvant chemotherapy
  • Diagnostic modalities
  • Triage process

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  • This study is part of the corresponding authors PhD project. The project has received grants from the following public and private funds: The Copenhagen University Hospital Research Foundation, Manufacturer Einar Willumsens Memorial Trust, the Capital Region of Denmark Research Foundation, the Arvid Nilsson Foundation, the King Christian X Foundation, the Dagmar Marshall Foundation, the Danish Research Foundation, the Hans and Nora Buchard Foundation, and the Krista and Viggo Petersen Foundation, civil engineer Bent Bøgh and spouse Inge Bøgh Foundation, the Torben and Alice Frimodts Foundation, and Dr Edgar Schnohr, DMSc, and spouse Gilberte Schnohr Foundation. However, none of these funds have any commercial, economic, or political interests in the results of this study, and hence, the results are not influenced by any of the funds.