This study aimed to identify the clinical and sociodemographic risk factors and compare cancer stage, treatment, and survival outcomes associated with ovarian cancer diagnosed following an emergency presentation versus other routes. A systematic search of Embase and MEDLINE was conducted from January 2000 to August 2025, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (PROSPERO: CRD420251111636). Studies were included if they examined risk factors associated with ovarian cancer diagnosis following an emergency presentation. Studies were also included if they compared treatment or survival outcomes between those diagnosed after an emergency presentation and those diagnosed via other routes. The quality of the studies was assessed using the Newcastle-Ottawa scale. Of the 3499 studies identified, 12 met the inclusion criteria and included a total of 127,395 women. All of the studies were conducted in high-income countries. Older age and socioeconomic deprivation were the most common determinants of an ovarian cancer diagnosis following an emergency presentation, although most studies did not adjust for key confounders. This diagnostic route was associated with advanced tumor stage, lower rates of treatment, shorter intervals between diagnosis and treatment initiation, and poorer survival outcomes. While the included studies were at low risk of bias, substantial heterogeneity made cross-study comparison challenging, especially as contradictory findings between larger population-based studies and single-center studies were noted. Women diagnosed with ovarian cancer following an emergency admission have a poor prognosis in many high-income countries. Urgent concerted action is needed to both decrease the number of women diagnosed through this diagnostic pathway and increase their treatment rates to improve survival outcomes.

Preoperative cardiopulmonary exercise testing (CPET) provides an objective measure of a patient’s functional capacity under stress. However, the association between CPET and long-term outcomes for women with ovarian cancer have not been assessed. The aim was to determine whether cardiorespiratory fitness, as measured by CPET parameters—peak oxygen uptake (VO2 peak), ventilatory efficiency at anaerobic threshold (VE/VCO2 at AT), and anaerobic threshold (AT)—could predict overall survival (OS) and recurrence -free survival (RFS) in patients with all stages of ovarian cancer. Methods: This was a retrospective cohort study of patients who underwent CPET prior to surgery for suspected or confirmed ovarian cancer during 2019–2023 at the Northern Gynaecological Oncology Centre, United Kingdom. CPET outcomes were risk-stratified, with thresholds of AT ≥ 10 mL/min, VO2 peak ≥ 15 mL/kg/min, and VE/VCO2 at AT ≤ 34 indicating lower risk. Primary outcomes included OS and RFS. Results: A total of 303 patients were included, of whom 56 (18.5%) had a staging laparotomy, 130 (42.9%) underwent primary cytoreductive surgery, and 117 (38.6%) underwent interval cytoreductive surgery. Survival analysis showed that VO2 peak ≥ 15 was significantly associated with improved OS of the whole population (p = 0.032). VE/VCO2 at AT ≤ 34 was associated with improved survival in patients with advanced stage disease (p = 0.025) after ovarian cancer surgery. There was no association between CPET parameters and RFS. Conclusions: We found that peak VO2 ≥ 15 was associated with improvement of overall survival in patients with all stages of ovarian cancer. In addition, VE/VCO2 at AT ≤ 34 was associated with overall survival in patients with advanced-stage disease.

Background: The COVID-19 pandemic substantially disrupted healthcare systems worldwide, raising concerns regarding delays in diagnosis, alterations in treatment pathways, and oncological outcomes for women with advanced ovarian cancer (AOC). This study evaluated the impact of the pandemic on the management and survival of patients with AOC treated at a high-volume ESGO-accredited tertiary gynaecological oncology centre. Methods: A retrospective cohort study was conducted using a prospectively maintained database of consecutive women diagnosed with FIGO stage III–IV epithelial ovarian, fallopian tube or primary peritoneal cancer between January 2017 and December 2022. Patients were divided into pre-pandemic and pandemic cohorts. Demographic characteristics, FIGO stage, treatment pathways, surgical outcomes, and overall survival were compared. Survival was analysed using Kaplan–Meier methodology and multivariable Cox proportional hazards regression was performed to evaluate the independent association between the pandemic period and overall survival after adjustment for age, FIGO stage, ECOG performance status and treatment modality. Results: A total of 700 patients were included, 406 patients treated before the pandemic and 294 during the pandemic. Patients diagnosed during the pandemic had a better ECOG performance status, but 51.3% presented with FIGO stage IV disease. Overall treatment rates were maintained (84.4% vs. 87.4% pre-pandemic), although treatment strategies shifted towards increased use of neoadjuvant chemotherapy (55% vs. 42.4%, p < 001), with a greater proportion of patients subsequently undergoing interval debulking surgery. Complete cytoreduction following interval debulking surgery was preserved throughout the study period, despite more advanced disease at presentation. One-year overall survival was similar between cohorts (69% vs. 72.2% pre-pandemic), whereas three-year overall survival was significantly lower among patients treated during the pandemic (36.1% vs. 45.1%). On multivariable Cox regression analysis, treatment during the pandemic remained independently associated with poorer overall survival after adjustment for clinically relevant baseline factors. Conclusions: Despite unprecedented disruption to healthcare services, specialist gynaecological oncology care has maintained access to multimodality treatment and preserved maximal effort cytoreductive surgery. Nevertheless, patients diagnosed during the pandemic experienced inferior long-term survival independent of baseline disease characteristics and treatment allocation, highlighting the broader indirect consequences of the pandemic on cancer outcomes. These findings emphasise the importance of protecting diagnostic pathways, multidisciplinary cancer services and surgical capacity during future healthcare crises.