Symptoms, Diagnoses, and Time to Key Diagnostic Procedures Among Older U.S. Women With Ovarian Cancer

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Abstract
To examine the types of symptoms and diagnostic procedures reported in Medicare claims 12 months before diagnosis for women with ovarian cancer by stage, and to assess the association between types of symptoms and time to key diagnostic procedures. Medicare claims linked to records in the Surveillance, Epidemiology, and End Results (SEER) cancer registries were used to examine diagnosis and procedure codes in 3,250 women aged 65 years and older before a diagnosis of ovarian cancer. Over 81% of women with ovarian cancer had at least one target sign or symptom before diagnosis. Gastrointestinal symptoms such as nausea and vomiting (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.40-2.98), and constipation, diarrhea, or other digestive disorders (aOR 2.01, 95% CI 1.58-2.56) were associated with later-stage cancer. In contrast, gynecologic symptoms such as abnormal bleeding (aOR 0.44, 95% CI 0.34-0.58) and genital organ pain (aOR 0.66, 95% CI 0.53-0.80) were associated with earlier disease. Among those with at least one symptom, the rate at which women with gynecologic symptoms went to surgery was higher (hazard ratio 5.5, 95% CI 5.1-6.0) than the rate for women with other nongastrointestinal ovarian cancer-related symptoms. Women with ovarian cancer presenting with gastrointestinal symptoms were more likely to have later-stage disease and longer time to key diagnostic tests than those with gynecologic symptoms. Clinicians should be aware of the potential for unresolved gastrointestinal symptoms to be indicators for ovarian cancer.