Evidence map›Paper›PMID 32561125›Full record

ArticleGynecologic oncology2020

Ovarian cancer symptoms, routes to diagnosis and survival - Population cohort study in the 'no screen' arm of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).

James Dilley, Matthew Burnell, Aleksandra Gentry-Maharaj, Andy Ryan, Christina Neophytou, Sophia Apostolidou, Chloe Karpinskyj, Jatinderpal Kalsi, Tim Mould, Robert Woolas and 9 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Gynecologic oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
40citing papers in PubMed, 1 pooled it
6.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

40 citing papers in PubMed, 1 synthesis or guideline pooled it, 75 citations in OpenAlex.

  1. The experience and supportive care needs in people affected by ovarian cancer and their informal caregivers: a qualitative systematic review.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
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  7. 27-Hydroxycholesterol in cancer development and drug resistance.Journal of enzyme inhibition and medicinal chemistry · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 10 institutions in 3 countries.

James DilleyMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK.
Matthew BurnellMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK.
Aleksandra Gentry-MaharajMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK.
Andy RyanMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK.
Christina NeophytouMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK.
Sophia ApostolidouMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK.
Chloe KarpinskyjMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK.
Jatinderpal KalsiInstitute for Women's Health, University College London, UK.
Tim MouldUniversity College London Hospital, UK.
Robert WoolasQueen Alexandra Hospital, Portsmouth, UK.
Naveena SinghBarts Health NHS Trust, UK.
Martin WidschwendterInstitute for Women's Health, University College London, UK.
Lesley FallowfieldSussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, UK.
Stuart CampbellCreate Health London, UK.
Steven J SkatesMassachusetts General Hospital and Harvard Medical School, USA.
Alistair McGuireLondon School of Economics, UK.
Mahesh ParmarMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK.
Ian JacobsUniversity of New South Wales, Australia.
Usha MenonMRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, UK. Electronic address: u.menon@ucl.ac.uk.
MRC Clinical Trials Unit at UCL · GBUniversity College London · GBBarts Health NHS Trust · GBCREATe Centre · GBHarvard University · USLondon School of Economics and Political Science · GBLondon Women's Clinic · GBQueen Alexandra Hospital · GBUniversity of Sussex · GBUNSW Sydney · AU

Funding

Cancer Research UK C1479/A2884Department of Health 16/46/01Medical Research Council G0000735Medical Research Council G0801228Medical Research Council G9901012Medical Research Council MC_UU_12023/28
6 · The paper itself

Abstract

objectiveThere are widespread efforts to increase symptom awareness of 'pelvic/abdominal pain, increased abdominal size/bloating, difficulty eating/feeling full and urinary frequency/urgency' in an attempt to diagnose ovarian cancer earlier. Long-term survival of women with these symptoms adjusted for known prognostic factors is yet to be determined. This study explored the association of symptoms, routes and interval to diagnosis and long-term survival in a population-based cohort of postmenopausal women diagnosed with invasive epithelial tubo-ovarian cancer (iEOC) in the 'no screen' (control) UKCTOCS arm.

methodsOf 101,299 women in the control arm, 574 were confirmed on outcome review to have iEOC between randomisation (2001-2005) and 31 December 2014. Data was extracted from medical notes and electronic records. A multivariable model was fitted for individual symptoms, time interval from symptom onset to diagnosis, route to diagnosis, speciality, morphological Type, age at diagnosis, year of diagnosis (period effect), stage, primary treatment, and residual disease.

resultsWomen presenting with symptoms listed in the NICE guidelines (HR1.48, 95%CI1.16-1.89, p = 0.001) or the modified Goff Index (HR1·68, 95%CI1·32-2.13, p < 0.0001) had significantly worse survival than those who did not. Each additional presenting symptom decreased survival (HR1·20, 95%CI1·12-1·28, p < 0.0001). In multivariable analysis, in addition to advanced stage, increasing residual disease and inadequate primary treatment, abdominal pain and loss of appetite/feeling full were significantly associated with increased mortality.

conclusionsThe ovarian cancer symptom indices identify postmenopausal women with a poorer prognosis. This study however cannot exclude the possibility of better outcomes in those who are aware and act on their symptoms.

Indexed as

Carcinoma, Ovarian EpithelialCohort StudiesEarly Detection of CancerFemaleHumansMiddle AgedOvarian NeoplasmsPrognosisRandomized Controlled Trials as TopicUnited KingdomGOFF indexNICEOvarian cancerRoutes to diagnosisSurvivalSymptomsUKCTOCS

Identifiers

PMID32561125
PMCPMC7453382
OpenAlexW3035791867

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.