Lesley F. Roberts

Ovarian Cancer in the Older Manitoban Population—Treatment Tolerance and Cancer-Related Outcomes: A Manitoba Ovarian Cancer Outcomes (MOCO) Group Study

Background: In Canada, individuals with gynecologic reproductive organs (ovaries, fallopian tubes, uterus) over the age of 70 comprise a large proportion of epithelial ovarian cancer patients. These patients often have co-morbidities, polypharmacy, or decreased functional status that may impact treatment initiation and tolerance. Despite this, there is limited evidence to guide treatment for older patients diagnosed with ovarian epithelial carcinoma. Methods: This is a retrospective study with data from Manitoba, Canada. The data were obtained from the Manitoba Ovarian Cancer Database, the Manitoba Cancer Registry, and electronic health records. All individuals with epithelial ovarian, fallopian tube, or peritoneal cancer diagnosed between 2009 and 2018 were identified. Patients aged > 70 at the time of diagnosis were included in the study cohort. Results: Four hundred and forty individuals were included. The majority had advanced stage disease (56%). Moreover, 59% of patients received no chemotherapy. Of the patients who received chemotherapy, 20% received <2 cycles and 21% required a dose reduction due to toxicity. Univariable and multivariable analysis identified advanced stage (p < 0.001), treatment modality (p < 0.001), and advanced age at diagnosis (p < 0.001) with poorer overall survival. Conclusions: Our study demonstrated a high rate of chemotherapy dose reduction and discontinuation in the elderly epithelial ovarian cancer population. Further research is needed to identify risk factors for treatment discontinuation and intolerance in this population.

Surgically Treated Cervical Cancer in Manitoba: A Retrospective Study of the Impact of Geography on Care

Background/Objectives: Cervical cancer outcomes based on geographic location of residence reveal inconsistent patterns, and most of the evidence is from the United States. This retrospective study aimed to investigate whether there existed a difference in overall survival (OS) and recurrence-free survival (RFS) between individuals living within a Canadian city with a tertiary care centre versus those living remotely within a large catchment area (up to >1000 km travel distance), including a sizeable rural component. Methods: Surgically treated cervical cancer patients from 2000 to 2016 were included. Patients were treated with either radical hysterectomy, trachelectomy, or simple hysterectomy. Adjuvant treatment was provided depending on surgical pathology. OS and RFS were estimated using Kaplan–Meier curves and cumulative incidence curves. Results: Two hundred and eighty-two patients with surgically treated cervical cancer were included: 185 patients living within urban city limits and 97 patients living rurally. There were no significant baseline differences between groups. No significant difference in OS or RFS was found, even after adjusting for death as a competing risk for RFS. The median time to surgery for residents living within versus outside the city was 84 vs. 66 days, respectively, although this difference was not statistically significant (p = 0.3179). Conclusions: This is the first Canadian study to examine an association between survival and distance to care for cervical cancer.