Summary
A nested case control study found that certain recurring symptoms associated with the abdominal and pelvic areas, as well as pain, appear to indicate an association with ovarian cancer, according to finding presented at the ASCO 2020 Annual Meeting (Abstract 6063).
“Women that are diagnosed with ovarian cancer are usually at a very late stage of the disease. Sixty percent are diagnosed at a stage III or IV and in many cases it has metastasized,” noted study author Denise Manon Langabeer, MBA, PhD, from The University of Texas MD Anderson Cancer Center.
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Original Article
Study Emphasizes Importance of Symptom Awareness in Ovarian Cancer Diagnosis
Oncology Times
By Catlin Nalley
A nested case control study found that certain recurring symptoms associated with the abdominal and pelvic areas, as well as pain, appear to indicate an association with ovarian cancer, according to finding presented at the ASCO 2020 Annual Meeting (Abstract 6063).
“Women that are diagnosed with ovarian cancer are usually at a very late stage of the disease. Sixty percent are diagnosed at a stage III or IV and in many cases it has metastasized,” noted study author Denise Manon Langabeer, MBA, PhD, from The University of Texas MD Anderson Cancer Center.
“As of today, in the U.S., there is no standardized screening test that is universally accepted,” she continued. “The objective of our study was to evaluate a taxonomy of symptoms that women may experience prior to the diagnosis of this disease.”
Study Overview
The researchers sought to determine if certain symptoms—based on ICD-9 categories—were distinguishable in women diagnosed with or without ovarian cancer. The analysis was based on 1,578 women (789 cases; 789 controls).
“Women diagnosed with ovarian cancer were randomly matched 1:1 to women without cancer to support a nested case-control analysis of health insurance claims between 2008 through 2013 from a commercial payer,” the study authors outlined in their poster presentation.
Eligible patients were 24 years or older, continuously enrolled in a health care plan for a minimum of 6 months and experienced more than one symptom over an observation period of at least 6 months.
“Our methods included a retrospective analysis of claims data over a 5-year period from a major payer,” Langabeer explained. “A total of 47 ICD-9 codes were categorized into four groups: abdominal and pelvic, digestive, bladder, and pain.
“As part of this study, we incorporated a 1-to-1 match between women that were diagnosed with ovarian cancer to women with no history of cancer,” she continued. “The criteria for the match included age at first symptom, first symptom experienced, and number of observation months.
“This research reports both the descriptive analysis as well as estimates of odds ratio with a 95 percent confidence interval, and statistical significance for the comparison of type of symptoms in cases and controls and comparison of combination of symptoms experienced.”
The researchers found that 90 percent (n=1,421) of women experienced abdominal and pelvic symptoms, and 92 percent (n=725) of the women with ovarian cancer visited their physician for this complaint 6-70 months prior to diagnosis.
“This appears to support some level of risk towards ovarian cancer, with an odds ratio of 1.66 and a p value of 0.008,” noted Langabeer. “Other symptoms associated with digestive, pain, and bladder were also analyzed individually and in combination.”
“Pain was reported as a complaint by cases at nearly 60 percent (n=464) and controls at 48% (n=376); OR 1.75 (CI 1.39 to 2.19; p < .001),” the study authors reported. “Symptoms for bladder and digestive combined represented 68 percent of complaints for both cases (n=507) and controls (n=555), p = .024 and p = .298, respectively.”
Among all women, 77 percent (cases=621; controls=595) experienced more than one category of symptoms. Both cases (n=206) and controls (n = 153) complained of abdomen and pelvic symptoms along with pain. Researchers observed a second combination in 14 percent of women that included abdomen and pelvic symptoms with pain and digestive symptoms (cases n=99; controls n=67).
Sixty percent (n=473) of diagnosed women experienced most of the associated pre-diagnosed symptoms analyzed for this research, the study authors noted. For women with ovarian cancer, the average number of visits prior to receiving a diagnosis was five and the median age at first symptom was 51 years old.
Given ovarian cancer is often diagnosed at a late stage and there are currently no routine screening methods to support early detection, the study authors noted that this research signifies the ongoing importance of symptom awareness.
“We believe this study remains relevant as this type of cancer continues to have a poor prognosis for many women,” Langabeer concluded. “We are planning to continue our research through a secondary analysis of the healthy women looking at a time period post the 5 years from this data set.”
Catlin Nalley is a contributing writer.