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Causes of death among women with epithelial ovarian cancer by length of survival post-diagnosis: a population-based study in British Columbia, Canada
  1. Nimisha Arora1,
  2. Aline Talhouk1,
  3. Jessica N. McAlpine1,
  4. Michael R. Law2 and
  5. Gillian E. Hanley1
  1. 1 Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Gillian E. Hanley, Diamond Health Care Center, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada; Gillian.hanley{at}vch.ca

Abstract

Objectives Little is known regarding the health of women who survive more than 5 years following their ovarian cancer diagnosis. To bridge an important gap in our knowledge about long term health of ovarian cancer survivors, we examined the causes of death among women diagnosed with epithelial ovarian cancer between 1990 and 2014 in British Columbia. These causes were stratified by years since diagnosis, and compared with age- standardized causes of death among women who have not been diagnosed with ovarian cancer.

Methods We examined all women with epithelial ovarian cancer in British Columbia 1990–2014 using population- based administrative datasets. We stratified women into three groups: all epithelial ovarian cancer patients; women surviving 5 to 9 years post-diagnosis, and women surviving 10 or more years since diagnosis. All- cause and cause specific standardized mortality ratios (SMRs) were calculated.

Results There were 4246 deaths among 6427 women with epithelial ovarian cancer. About 55.9% of deaths were from ovarian cancer. When compared with the general population, the highest SMRs (SMR of 5 or higher) were for deaths from other cancers and external causes (44.4% from falls) among women surviving 5–9 years and 10 or more years post-diagnosis. Mortality from other cancers can largely be explained by deaths from breast cancer (15.8%), lung cancer (12.3%), and colorectal cancer (11%).

Conclusions While the majority of epithelial ovarian cancer patients continue to die from their ovarian cancer, our results suggest that long term ovarian cancer survivors are particularly vulnerable to deaths from other cancers and from falls in elderly survivors. These data could indicate closer surveillance for breast, lung, and colorectal cancer, and closer attention to bone health is warranted among women surviving for 5 or more years following their epithelial ovarian cancer diagnosis.

  • ovarian cancer
  • long term survivors
  • mortality
  • standardized mortality ratio
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Footnotes

  • Contributors NA and GH came up with the study proposal and wrote the manuscript. NA performed the data analysis, prepared tables. GH assisted NA in the analysis and interpretation of the data. AT, JM, ML contributed to manuscript revision. The final draft of the manuscript was read and approved by all the authors.

  • Funding Canadian Cancer Society Research Institute, Canadian Institutes for Health Research, Vancouver General Hospital, and University of British Columbia Hospital Foundation.

  • Competing interests None declared.

  • Ethics approval The University of British Columbia’s behavioural research ethics board has approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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