Treatment Outcome and Associated Factors for Ovarian Cancer Patients Attended at Ocean Road Cancer Institute Dar Es Salaam, Tanzania

Abstract

Ovarian cancer is a common malignancy among women in Tanzania and worldwide. It is associated with high morbidity and mortality especially in developing countries. Surgery and chemotherapy plays major role in the management of ovarian cancer. Response to treatment is influenced by several clinical factors like disease stage, initial tumor burden, histology, performance status of the patient, modality of treatment and age of the patient. Objective: To explore the social demographic characteristics, histological presentation, treatment modalities and treatment outcome of the patients with ovarian cancer who had attended at Ocean Road Cancer Institute, Tanzania from 2012 to 2016. Patients and methods: This is a retrospective cross sectional study designed to determine one year overall survival among ovarian cancer patients, and factors related to it. Data were obtained from patients medical files and filled into data collection form. Data was collected from patients who were diagnosed from January 2012 to January 2016. This study was done at Ocean Road Cancer Institute, Dar Es Salaam. A total of 96 patients with ovarian carcinoma with all stages and histological confirmation, were followed up one year post treatment. Patients were treated either with surgery alone, or surgery then chemotherapy or neoadjuvant chemotherapy followed by surgery then adjuvant chemotherapy, and lastly those who received chemotherapy alone. Evaluation and analysis: Patients were evaluated one year post treatment. Survival was evaluated using Kaplan Meir method. Social demographic and Clinical factors were analyzed using frequency and percentage as well as mean and standard deviation. Survival curves were estimated by the Kaplan-Meier method. To identify factors predictive of survival outcome the variables were analyzed by univariate analysis by using log-rank test and multivariate analysis by using Cox Regression model. All drop outs were considered as censored. An association was regarded as statistical significance if the p-value < 0.05. Results: A total of 96 patients were included in the analysis among them 22 were in curative intent group (treated according to NCCN protocol and ORCI protocol for ovarian cancer) and 74 were in palliative intent group (all patients who were under treated). Mean age 51.4 years with the range of 19 years up to 97 years, standard deviation of 17.3. Most patients had epithelial cell tumor about 85.4%. In most patients, 55.2%, surgery was done first followed by chemotherapy while 27.1% had surgery alone and about 12.5%, received chemotherapy alone and only 5.2 % received neoadjuvant chemotherapy followed by surgery and then finished up with adjuvant chemotherapy. Most patients received taxanes and platinum based chemotherapy (60.3%), followed by BEP (Bleomycin, Etoposide and Cisplatin) 6.3% patients and other chemotherapy regimen 6.3%. Among patients who received chemotherapy only 27% received more than 6 cycles. Overall survival and associated factors: After one year, among 22 patients who were in curative intent group, only 4 had passed away while in palliative group we had 74 patients and 40 patients had passed away after one year post treatment. Patients who have received curative treatment had more survival 82% as compared to the patients who had received palliative treatment 40% (P value 0.003). In both curative intent and palliative intent group, patients who received chemotherapy less than 35 days from time they had surgery had better survival compared to patients who received chemotherapy more than 35 days from surgery with p value 0.02 and 0.001 respectively. In curative intent group, OS was favoured more in age below 51 years (p value 0.001). Patients with no residual disease, early stage and less than ECOG 2, had better OS, though the association was not statistically significant. Also OS had no association with histological type of tumor, number of chemotherapy cycles or type of chemotherapy in curative intent group. In palliative intent group, patients who came earlier to ORCI for adjuvant treatment(within 30 days of surgery) had better survival when compared to patients who came late and the association was statistically significant (p=0.001). Furthermore, in this group patients who had ECOG status less than 2 and FIGO stage three had better survival with p value 0.04 and p=0.04 respectively. There was no association between OS and histology type (p=0.907), number of cycles (p=0.667) nor treatment modality in palliative intent group (p=0.135). Conclusion: The study has shown that patients in curative intent group had greater survival than in palliative intent group and in both groups, delay in starting chemotherapy more than 35 days after surgery is associated with poor overall survival. In curative intent group, younger age was associated with good Overall survival while in palliative intent group poor ECOG status was associated with poor overall survival.