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Abstract
Introduction/Background While the discourse in ovarian cancer treatment predominantly focuses on comparing primary and interval debulking surgeries, a significant subset of patients, exceeding 15%, never experience debulking surgery. This study aims to elucidate the demographic, socioeconomic, and health-related characteristics of these patients, and to analyze their overall survival outcomes.
Methodology Utilizing data from the French national health insurance system database, which encompasses 98.8% of France’s 67 million residents, this research included patients diagnosed with advanced ovarian cancer from 2014 to 2022. We employed a hierarchical multivariable binomial model to distinguish the unique characteristics of patients who did not undergo debulking surgery. Additionally, Kaplan-Meier curves and an Inverse Probability Weighted (IPW) Cox model were used to analyze and illustrate their overall survival trends.
Results Among 22,521 ovarian cancer patients analyzed, 3,780 (16.8%) had not undergone any cytoreductive surgery. These patients were predominantly older, with higher comorbidity rates. Additionally, they faced greater socio-environmental challenges, including economic deprivation, educational barriers, digital barriers, healthcare inaccessibility, social isolation, familial hardship, and racial segregation. Treatment in nonacademic centers and facilities with limited oncological and surgical expertise was more common in this group. Absence of cytoreductive surgery markedly affected overall survival, irrespective of initial cancer stage or metastasis location. The 5-year overall survival was respectively 39%, 46% and 62% in the non-surgery, interval and primary debulking surgery groups. The IPW Cox model revealed a hazard ratio for death of 1.4 [1.2;1.6] in the non-surgery group compared to those who underwent surgery.
Conclusion This study highlights the critical disparities faced by a substantial yet often ignored fraction of ovarian cancer patients who do not receive debulking surgery. These findings underscore the need for tailored healthcare strategies that address the multifaceted barriers faced by this vulnerable group.
Disclosures None.
