Patterns of palliative care referral in ovarian cancer: A single institution 5 year retrospective analysis

Gynecol Oncol. 2018 Mar;148(3):521-526. doi: 10.1016/j.ygyno.2018.01.018. Epub 2018 Feb 12.


Background: The American Society of Clinical Oncology recommends that patients with advanced cancer receive dedicated palliative care services early in their disease course. This investigation serves to understand how palliative care services are utilized for ovarian cancer patients in a tertiary referral center.

Methods: We conducted a retrospective review of women treated for ovarian cancer at our institution from 2010 through 2015. Clinical variables included presence and timing of palliative care referral. Data were correlated utilizing univariable and multivariable parametric and non-parametric testing, and survivals were analyzed using the Kaplan-Meier method and cox-proportional hazard models.

Results: We identified 391 women treated for ovarian cancer, of whom 68% were diagnosed with stage III or IV disease. Palliative care referral was utilized in 28% in the outpatient (42%) and inpatient (58%) settings. Earlier use of referral was observed in those who never underwent surgical cytoreduction or had interval cytoreductive surgery (p < 0.001). Palliative care referral was independently associated with advanced stage (OR 1.7, p = 0.02), recurrence (OR 2.0, p = 0.002) and hospice referral (OR 6.0, p < 0.001). In 38% of women referral occurred within 30 days of death, and 17% within one week of death. Outpatient initial consultation was associated with an unadjusted 1 year overall survival benefit (p < 0.01) compared to inpatient consultation.

Conclusions: The outcomes in this study suggest a late use of palliative care that is reactionary to patient needs and not a routine component of ovarian cancer care as national guidelines recommend.

Keywords: Ovarian cancer; Palliative care; Quality of life.

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / therapy*
  • Adenocarcinoma, Clear Cell / pathology
  • Adenocarcinoma, Clear Cell / therapy
  • Adenocarcinoma, Mucinous / pathology
  • Adenocarcinoma, Mucinous / therapy
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care
  • Carcinoma, Endometrioid / pathology
  • Carcinoma, Endometrioid / therapy
  • Carcinosarcoma / pathology
  • Carcinosarcoma / therapy*
  • Cytoreduction Surgical Procedures / statistics & numerical data
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Neoplasms, Cystic, Mucinous, and Serous / pathology
  • Neoplasms, Cystic, Mucinous, and Serous / therapy*
  • Neoplasms, Germ Cell and Embryonal / pathology
  • Neoplasms, Germ Cell and Embryonal / therapy*
  • Odds Ratio
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / therapy*
  • Palliative Care*
  • Prognosis
  • Proportional Hazards Models
  • Quality of Life
  • Referral and Consultation / statistics & numerical data*
  • Retrospective Studies
  • Sex Cord-Gonadal Stromal Tumors / pathology
  • Sex Cord-Gonadal Stromal Tumors / therapy*
  • Survival Rate
  • Time Factors
  • Young Adult