Improving outcomes in older women with ovarian cancer

Abstract

Background: Older women have disproportionately poorer survival outcomes for ovarian cancer. Sarcopenia, the loss of muscle mass and density is of interest as a potential non-invasive biomarker of frailty. Little is documented on decision-making and treatment experience of older women. Given the rising proportion of older patients in oncology clinics, novel approaches to enable oncology teams to deliver a geriatric assessment and crucially, interventions to address deficits identified are required. Aims: To evaluate patient characteristics, treatment patterns, tolerance and survival outcomes in older women treated for ovarian cancer. To assess whether reduced muscle mass and density at baseline and during treatment is associated with poorer treatment tolerance and survival outcomes. To assess the decision-making and treatment experience of older women. To develop and open a clinical trial implementing a GA and protocolled interventions to address deficits identified in the routine oncology clinic. Methods: The chapters of this thesis cover: A literature review of outcomes of older women with ovarian cancer. Outcomes of 280 women aged >65 years treated at two UK cancer centres. The impact of sarcopenia in women over the age of 65 treatment tolerance and outcomes. Treatment experience in women over the age of 65. The development of a novel prospective, interventional clinical trial implementing a GA and algorithms to address deficits identified. Results: Age was not independently associated with poorer survival outcomes once stage and treatment factors are adjusted for. Muscle density but not mass was strongly associated with poorer survival outcomes. Older women with ovarian cancer were overwhelmingly positive about their care experience and desire for anticancer treatment despite logistical burden and toxicities. The FAIR-O study opened in January 2021. Conclusions: Reduced treatment intensity is one of the principal factors in the poorer survival outcomes in the oldest patient. Biomarkers such as sarcopenia can be used to help to risk stratify patients. The multi-centre FAIR-O study will assess whether it is feasible for oncology teams to undertake a GA and targeted interventions when indicated.