Socioeconomic differences impact overall survival in advanced ovarian cancer (AOC) prior to achievement of standard therapy

  • Andrew PhillipsEmail author
  • Sean Kehoe
  • Kavita Singh
  • Ahmed Elattar
  • James Nevin
  • Janos Balega
  • Rachel Pounds
  • Ahmed Elmodir
  • Jennifer Pascoe
  • Indrajit Fernando
  • Sudha Sundar
General Gynecology



Survival difference between socioeconomic groups with ovarian cancer has persisted in the United Kingdom despite efforts to reduce disparities in care. Our aim was to delineate critical episodes in the patient journey, where deprivation has most impact on survival.


A retrospective review of 834 patients with advanced ovarian cancer (AOC) between 16/8/07–16/2/17 at a large cancer centre serving one of the most deprived areas of the UK. Using the Index of Multiple Deprivation (IMD), patients were categorised into five groups.


Surgery was more common in less deprived patients (p < 0.00001). Across IMD groups, there were no differences in complete (R0) cytoreduction rate (r = 0.18, p > 0.05), age, or comorbidity. The R0/total cohort rate increased with increasing IMD group (p < 0.0001). Patients refusing any intervention belonged exclusively to the three most deprived groups; 5/7 patients who refused surgery belonged to the most deprived IMD group. Overall survival in the total patient group was less in IMD group 1–2 compared to 9–10 (p = 0.002). On multivariate analysis, IMD group was not an independent predictor of survival (p > 0.05).


Socioeconomic differences in survival manifest in patients not receiving surgical treatment for AOC and are not purely explained by comorbidity, age, stage, or histological factors.


Deprivation Ovarian Cancer Cytoreduction Charlson 


Compliance with ethical standards

Conflict of interest

Sean Kehoe has received fees for lecturing for Astra Zeneca and Roche. Janos Balega has received personal fees from Astra Zeneca and Roche. Jennifer Pascoe has received personal fees from Tesaro. All other authors declare that we have no conflict of interest.

Ethical approval

Approval for this retrospective study with no patient intervention was obtained from the hospitals research and development department. (Sandwell and West Birmingham Hospitals NHS Trust Research and Development department).

Informed consent

No identifiable patient details were included in this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Andrew Phillips
    • 1
    • 2
    Email author
  • Sean Kehoe
    • 2
    • 3
  • Kavita Singh
    • 2
  • Ahmed Elattar
    • 2
  • James Nevin
    • 2
  • Janos Balega
    • 2
  • Rachel Pounds
    • 2
  • Ahmed Elmodir
    • 4
  • Jennifer Pascoe
    • 4
  • Indrajit Fernando
    • 4
  • Sudha Sundar
    • 2
    • 3
  1. 1.Department of Obstetrics and GynaecologyRoyal Derby HospitalDerbyUK
  2. 2.Pan-Birmingham Gynaecological Cancer CentreCity HospitalBirminghamUK
  3. 3.Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
  4. 4.The Cancer CentreQueen Elizabeth HospitalBirminghamUK

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