Dr William Cliby: Patient Factors and Surgery, Quality of Care For Ovarian Cancer

William Cliby, MD, consultant, division of gynecologic surgery, department of obstetrics & gynecology, Mayo Clinic, discusses patient factors that predispose them to adverse complications during surgery for ovarian cancer and using those predictors to improve care.

Transcript

What patient factors would predispose them to adverse complications during surgery for ovarian cancer?

That’s very important. A big part of what we’ve been doing the last 10 or 15 years is identifying the risk factors for serious complications after ovarian cancer surgery. Of course, the importance of surgery in leaving very little residual disease on survival is known and accepted. But, sometimes doing those surgeries are quite complex, and patients can have bad complications as a result. So, we’ve identified that the factors that most predict complications are, again, the patient’s age, performance status, or some measure of their frailty, and then their nutrition level.

Patients that have any of those factors at are negative, they really have a high and probably unacceptably high risk from upfront surgery. So, they’re better served by some other way to address their ovarian cancer, perhaps adding in surgery later in the course of their treatment.

How can you use these predictors to improve quality of care and management of ovarian cancer?

So, for us, it’s about not taking a one size fits all approach. We shouldn’t treat most patients with chemotherapy first and then surgery, and we shouldn’t try to treat all patients with surgery first and then chemotherapy. Using these factors that I mentioned before, patient factors, as well as the treating centers factors, we can triage patients best to what they can tolerate to get them best overall care.

We’re not so focused on just the surgical outcomes. We’ve got a long battle to wage against ovarian cancer that we want to have the best overall outcome.