Geriatric co-management leads to safely performed cytoreductive surgery in older women with advanced stage ovarian cancer treated at a tertiary care cancer center Journal Article


Authors: Filippova, O. T.; Chi, D. S.; Long Roche, K.; Sonoda, Y.; Zivanovic, O.; Gardner, G. J.; Tew, W. P.; O'Cearbhaill, R.; Sarraf, S.; Sun, S. W.; Alexander, K.; Korc-Grodzicki, B.; Shahrokni, A.
Article Title: Geriatric co-management leads to safely performed cytoreductive surgery in older women with advanced stage ovarian cancer treated at a tertiary care cancer center
Abstract: Objective: To assess fitness and outcomes in older women undergoing cytoreductive surgery for advanced ovarian cancer (OC). Methods: A prospective study of OC patients referred to Geriatrics Clinic for preoperative evaluation. All completed the electronic Rapid Fitness Assessment (eRFA) and were followed by Geriatrics Service during inpatient postoperative course, co-managed by Surgical Service. Outcomes were 30-day Intensive Care Unit (ICU) admission, emergency room (ER) visit, readmission, mortality, adverse surgical events. Descriptive statistics were used. Results: Forty-two women (median age 79, range 74–88), 38 with newly diagnosed advanced OC, 4 with recurrent OC, underwent cytoreductive surgery between 5/2015 and 1/2018. Preoperative age-related impairments per eRFA: high level of distress (71%), functional dependency (59%), limited social activity (59%), depression (57%), slow Time Up and Go (54%), Karnofsky Performance Score (KPS) ≤ 80 (41%), poor social support (43%), polypharmacy (35%), weight loss>10 lbs. (25%), fall history (244%), cognitive impairment (13%). Median number of comorbid conditions = 3. Among 38 newly diagnosed women, 26 (68%) had stage IIIC, 11 (29%) stage IV. Sixteen (42%) underwent primary debulking surgery, 22 (58%) neoadjuvant chemotherapy followed by interval debulking surgery. Median duration of surgery = 245.5 min (range 95–621); median hospital length of stay = 6 days (range 0–22). Optimal debulking rate = 97%, complete gross resection rate = 63%. One patient was admitted to ICU, 26% had 30-day ER visit, 10% were readmitted. Any complication, minor complication, major complication occurred in 58%, 55%, 8%, respectively. Median time from surgery to postoperative chemotherapy = 34.5 days (range 19–66). Median follow-up = 15.7 months (range 3.7–38.0), 12-month survival = 93.3%. There was no 180-day mortality. Conclusion: Cytoreductive surgery among older women with advanced OC and frailty can be performed safely in a tertiary care center with preoperative/postoperative geriatric and surgical co-management. © 2019 Elsevier Inc.
Keywords: ovarian cancer; cytoreductive surgery; outcomes; geriatric assessment; co-management
Journal Title: Gynecologic Oncology
Volume: 154
Issue: 1
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2019-07-01
Start Page: 77
End Page: 82
Language: English
DOI: 10.1016/j.ygyno.2019.04.683
PUBMED: 31078241
PROVIDER: scopus
PMCID: PMC6589387
DOI/URL:
Notes: Article -- Export Date: 1 July 2019 -- Source: Scopus
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MSK Authors
  1. Ginger J Gardner
    140 Gardner
  2. Dennis S Chi
    508 Chi
  3. Yukio Sonoda
    293 Sonoda
  4. Oliver Zivanovic
    131 Zivanovic
  5. Sung Wu Sun
    6 Sun
  6. Kara Christine Long
    64 Long
  7. William P Tew
    140 Tew
  8. Saman Sarraf
    6 Sarraf