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April 22, 2021

Vulnerable Older Adults With Ovarian Cancer—Time to Stop Undertreating

Author Affiliations
  • 1Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
JAMA Oncol. 2021;7(6):831-833. doi:10.1001/jamaoncol.2021.0468

Each year more than 20 000 women are diagnosed with ovarian cancer, more than half of whom are older than 65 years. Older age is associated with increased risk for disease progression and death. With each 5-year increment of age after 65 years, survival diminishes; only 33% of those aged 80 to 84 years survive 1 year after diagnosis.1 Prospective and retrospective studies have demonstrated that with aging comes an increase in treatment-related toxic effects and decrements in survival, receipt of chemotherapy and/or surgery, and involvement in clinical trials.2 The standard treatment of advanced ovarian cancer involves comprehensive cytoreductive surgery and 6 cycles of combination therapy with a platinum and taxane. Long-standing concerns regarding the increased risk of chemotherapy-associated toxic effects in vulnerable older adults owing to physiologic declines in organ function, increased comorbidities, and altered pharmacokinetics have led to shifts in the treatment paradigm for older patients. Older women, especially those 75 years and older, are less likely to receive standard combination therapy. Dose reduction, removal of taxane therapy, and adjustments in schedule are common.3 Delays in chemotherapy administration further decrease survival in older adult patients with ovarian cancer.4

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