Introduction/Background Epithelial ovarian cancer (EOC) is the most lethal gynaecological cancer for which long-term survival is conditioned by surgery and chemotherapy. Striking a balance between this comprehensive treatment combination and the patient population, with a substantial number of older women, poses a continuous challenge. Older patients with EOC repeatedly demonstrate poor survival compared to younger. Yet, age itself cannot explain the survival gap. We aimed to explore differences between older and younger patients regarding surgical complexity, chemotherapy management, and treatment delays in Denmark.

Methodology We included a nationwide cohort of patients diagnosed with EOC from 2013 to 2018. We described surgical complexity and outcomes, the extent of chemotherapy and treatment delays stratified by age (< 70 and ≥ 70 years), and surgical modality (primary, interval, or no debulking surgery). Finally, we assessed the cancer-specific survival.

Results We included 2,946 patients in total. For patients with advanced-stage disease, 52% of the older and 25% of the younger patients underwent neither primary debulking surgery (PDS) nor interval debulking surgery (IDS). For patients that did undergo PDS or IDS, older patients had less extensive surgery and were more likely to have residual disease after surgery than younger patients. Furthermore, chemotherapy was given less frequently to older patients. Yet, we found no differences across age cohorts regarding treatment delays according to national cancer patient pathways. Two-year cancer-specific survival differed significantly between age groups favouring the younger patients, regardless of whether patients underwent curatively intended treatment or not.

Conclusion Our study demonstrates that older patients receive less active surgical and oncological treatment than younger patients, resulting in lower cancer-specific survival. Treatment delays are not more common in older patients than in younger patients.