Symptom-related care and diagnoses before ovarian cancer detection: Patterns and differences by cancer stage.

OBJECTIVE: Most ovarian cancer (OC) patients are diagnosed at a late stage with poor survival. Factors that enable early-stage diagnoses are poorly understood; this study explores differences in pre-diagnostic healthcare utilization for relevant symptoms and diagnoses to identify factors potentially impacting stage at diagnosis. METHODS: We identified OC patients in the North Carolina state cancer registry (2009-2019) with linked multi-payer insurance claims in the year pre-diagnosis. We compared frequency of claims for symptoms of OC and diagnoses often initially ascribed to them, including anxiety, menopausal symptoms, and gastrointestinal disorders, during the month before OC diagnosis and earlier (1-12 months before), stratified by early vs. late-stage. RESULTS: Out of 2495 patients, 822 (33 %) were diagnosed at an early stage. On the absolute scale, patients with an early stage were nearly twice as likely to present with pelvic pain during the month pre-diagnosis (20 % (95 % CI:(17 %-23 %) vs.11 % (95 % CI:10-13 %)), with patients with late stage more frequently presenting with abdominal and gastrointestinal complaints. In the year pre-diagnosis, 54 % (95 % CI:51-57 %) of patients with early-stage and 52 % (95 % CI:50-54 %) with late-stage were diagnosed with a gastrointestinal disorder, most commonly gastroesophageal reflux disease (GERD). Over 20 % had healthcare encounters for a symptom or related diagnosis as early as 10 months before OC diagnosis. CONCLUSIONS: Differences in symptomatic presentation may explain some early-stage diagnoses, though these were minor. Gastrointestinal disorder diagnoses such as GERD may be an underappreciated hallmark of the pathway to OC diagnosis and should be considered when assessing time to diagnosis using claims.