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Treatment patterns and associated factors in patients with advanced epithelial ovarian cancer: a population-based study
  1. Myrte Zijlstra1,2,3,
  2. Maite Timmermans1,4,
  3. Heidi Fransen1,3,
  4. Maaike van der Aa1,
  5. An Reyners5,
  6. Natasja Raijmakers1,3 and
  7. Lonneke van de Poll-Franse1,6,7
  1. 1 Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
  2. 2 Department of Medical Oncology, Maxima Medical Centre, Eindhoven, The Netherlands
  3. 3 Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
  4. 4 Department of Gynaecology, Haga Hospital, The Hague, The Netherlands
  5. 5 Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  6. 6 CoRPS- Center of Research on Psychology in Somatic diseases, Department of Medicaland Clinical Psychology, Tilburg University, Tilburg, The Netherlands
  7. 7 Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
  1. Correspondence to Myrte Zijlstra, Netherlands Comprehensive Cancer Organisation (IKNL), PO box 19079 3501 DB Utrecht, The Netherlands; m.zijlstra{at}


Objectives A significant proportion of women with advanced-stage ovarian cancer receive no cancer-directed treatment and limited research has been devoted to this group. This population-based study aimed to gain insight into treatment patterns and trends in patients with advanced epithelial ovarian cancer in the Netherlands and the main reasons for deciding for no cancer-directed treatment.

Methods All patients diagnosed with advanced epithelial ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) classification IIB−IV, between 2008 and 2016 were identified from the Netherlands Cancer Registry. Trends in the number of patients receiving cancer-directed treatment were analyzed. Multivariable logistic regression analysis was used to identify factors associated with no cancer-directed treatment. The main reasons for no cancer-directed treatment were analyzed.

Results A total of 9303 patients were included, of whom 14% (n=1270) received no cancer-directed treatment while 67% (n=6218) received a combination of cytoreductive surgery and chemotherapy. Some 15% (n=1399) received chemotherapy only, and 4.5% (n=416) surgical resection or hormonal therapy only. The proportion of patients receiving no cancer-directed treatment was higher in 2014–2016 (16%, n=496/3175) compared with 2008–2010 (11%, n=349/3057, p<0.001). Associated factors with no cancer-directed treatment were higher age, FIGO stage IV, lower socioeconomic status, co-morbidity, and more recent years of diagnosis (p<0.001). Main reasons for no cancer-directed treatment were patient’s choice (40%) and poor condition of the patient (29%).

Conclusions The proportion of patients with advanced epithelial ovarian cancer not receiving cancer-directed treatment has increased in the last decade in the Netherlands. Patient’s choice was the main reason for the decision to undergo no cancer-directed treatment, which indicates patient involvement in the decision-making process. The second most common reason for no cancer-directed treatment was poor condition of the patient, which might indicate careful selection of patients for treatment. Decision-making regarding treatment is well-considered, but more insight is needed, especially from the patient's perspective.

  • ovarian neoplasms
  • quality of life (pro)/palliative care
  • palliative care
  • medical oncology
  • surgical oncology

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  • Contributors MZ, MT, HF, and NR designed and conducted the analysis and drafted the manuscript. All authors gave comments on drafts of the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.