Older patients with advanced ovarian cancer have higher rates of short-term morbidity and mortality, but there are ways to improve outcomes for these patients, according to a presentation at the ESMO Gynaecological Cancers Congress 2022.1
Accelerating diagnostic procedures and identifying geriatric vulnerability parameters are important, according to presenter Claire Falandry, MD, PhD, of Lyon Sud Hospital Center in Pierre-Bénite, France.
Dr Falandry also recommended avoiding emergency surgeries whenever possible and refraining from de-escalating therapy in patients who score high on standardized assessments of frailty.
Dr Falandry noted that age is a major contributor to early death for patients with advanced ovarian cancer. In a study of 9491 patients with stage III-IV ovarian cancer, 43.6% of patients died in the first year, and 26.0% died in the first 90 days after diagnosis.2 In a multivariate analysis, being older than 75 years of age was significantly associated with an increased risk of death at 90 days.
Surgery Can Increase Risk of Early Death
Emergency surgery is a predictor of poor short-term outcomes for older patients with ovarian cancer, according to a study by Thrall et al.3 The study included 5475 patients who were at least 65 years old and had surgery for advanced ovarian cancer. The 30-day mortality rate was 20.1% for patients who required emergency operations and 5.6% for those who had elective surgery.
To reduce the likelihood that older patients will need emergency surgery, Dr Falandry advised accelerating diagnostic testing and interventions and promptly referring patients to centers with expertise in gynecologic oncology and geriatric care.
Dr Falandry noted, however, that even elective surgical procedures can pose short-term risks in older patients. In the study by Thrall et al, advancing age was significantly associated with an increase in 30-day mortality for patients undergoing elective surgery.3
In a multivariable analysis of the elective surgery group, patients who were 80 to 84 years of age had a more than 2-fold increase in the risk of 30-day mortality, compared with patients ages 65 to 69 years (relative risk [RR], 2.10; 95% CI, 1.36-3.24). Patients who were 85 years of age or older had an almost 5-fold increase in the risk of 30-day mortality (RR, 4.77; 95% CI, 3.07-7.42).
Geriatric Vulnerability Score Can Guide Management
The geriatric vulnerability score (GVS) can reveal patients who are most at risk of premature death and might benefit from certain interventions, according to Dr Falandry.
The GVS assigns 1 point to the following risk factors: albumin level below 35 g/L, lymphopenia (<1 × 10⁹/L), Katz Index of Independence in Activities of Daily Living score below 6, Lawton Instrumental Activities of Daily Living Scale score below 25, and Hospital Anxiety and Depression Scale score greater than 14.4
Patients without any of these factors have a score of 0 and are the lowest risk group. Those with a score of 5 are the highest risk group.
The researchers who developed the GVS found that a cutoff of 3 divides patients into 2 groups with significant differences in treatment completion, unplanned hospitalizations, severe adverse events, and overall survival.
A more recent study validated the GVS, suggesting that it “has high prognostic performance for overall survival in patients with advanced ovarian cancer.”5
Dr Falandry said that each geriatric vulnerability parameter in the GVS provides a target for a specific intervention to enhance treatment outcomes, including nutritional care, functional enhancement, psychosocial support, and environmental modification.
Without considering overall frailty, chronologic age is not as accurate a predictor of outcomes in older patients with ovarian cancer, nor does it provide targets for focused intervention.