The impact of delayed surgical treatment of suspected stage I ovarian cancer: lessons for a pandemic

Darling, Alice Albright Benjamin Mayne Nicholas Yang Chi-Fu Jeffrey Berchuck Andrew Moss Haley

During the COVID-19 pandemic, the Society of Gynecologic Oncology and other medical societies provided guidelines about acceptable delays in oncologic treatments for patients with a suspected malignancy. The objective of this study was to characterize the association between timing of treatment and survival and to evaluate how extended delays to guideline-concordant treatment for suspected stage I high grade serous ovarian cancer might impact survival. Using the National Cancer Data Base (2004-2015), patients surgically treated for clinical stage I high grade serous ovarian cancer were identified. Patients receiving surgery within 14 days of diagnosis were compared to those receiving surgery 2-4 months after diagnosis. The groups were propensity matched with 2:1 matching to balance baseline characteristics. Survival outcomes of the two cohorts were assessed using Kaplan-Meier analysis, the log-rank test, and multivariable Cox proportional hazards analysis. During the study period, 10,957 patients underwent guideline-concordant surgery for stage I high-grade serous ovarian cancer within 14 days of diagnosis (early) and 171 patients underwent surgery 2-4 months following diagnosis (delayed). Between patients in the early versus delayed treatment groups, the delayed group was more likely to be Black (5.3% vs 11.8%, p=0.003) and have a smaller tumor size (8.0 vs. 6.2 cm, p<0.001). The early group was more likely to have private insurance (57.4% vs 44.9%, p=0.006). There was no significant difference in 5-year overall survival between the unmatched early versus delayed groups (56.6% vs 50.8%, p=0.36). Propensity-score 2:1 matching was used to create two groups of patients who received early (n=342) or delayed (n=171) surgery that were well-matched with regards to baseline characteristics. The only significant difference between groups in the matched cohort was patients in the delayed group had smaller tumors (8.0 vs 6.2 cm, p<0.001). There was no significant difference in 3-year overall survival (early 73.6% [95% confidence interval (CI): 68.2 - 78.2] vs delayed 72.6% [95% CI: 64.4 - 79.2]) or 5-year overall survival (early 56.6% [95% CI: 50.3 - 62.4] vs delayed 50.8% [95% CI: 41.6 - 59.3], log-rank p=0.52) between the early versus delayed groups (Figure 1). In Cox proportional hazards analysis, age in years (adjusted hazard ratio (aHR)=1.03, [CI: 1.01 - 1.04], p=0.003) and Charlson Deyo comorbidity composite score of 2 (aHR=2.58, [CI: 1.44 - 4.62], p=0.001) were associated with worse survival. Private insurance status was associated with improved overall survival (aHR=0.51, [CI: 0.27 - 0.96], p=0.04). Surgical delay was not significantly associated with different overall survival (aHR=1.19, [CI: 0.90 - 1.58], p=0.23). [Display omitted] In this national analysis, extended delay of treatment for stage I high grade serous ovarian cancer was associated with similar survival outcomes when compared to timely treatment in pre-match and post-match cohorts. In the setting of the COVID-19 pandemic, where hospital resources may be limited, delays in surgery are concerning and prompt oncologic treatment is preferred;however, at least based on these retrospective data, delays in surgery for presumed stage I ovarian cancer may not be associated with significantly worse survival. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)