Date of Award

Spring 5-2019

Degree Name

Doctor of Philosophy (PhD)



Second Advisor


Third Advisor



According to the American Cancer Society, approximately twenty percent (20% of women with ovarian cancer are diagnosed at an early stage (e.g. stage I or II), which subsequently means eighty percent (80%) of women diagnosed with this disease are at the late stage (e.g. stage III or IV) and are likely not to survive. No cure exists and, concurrently, studies show mixed results in utilizing blood tests and transvaginal ultrasounds to screen for ovarian cancer. While symptoms are not easily discernable, some oncologists have validated there are common symptoms women experience prior to diagnosis. As these symptoms are not routinely recognized by general practitioners as an indicator to detect ovarian cancer, we conducted a retrospective study to determine whether certain types of symptoms are evident prior to the diagnosis. Our two specific aims included: (1) conduct an exploratory study to determine if certain symptoms were prevalent in women that are diagnosed with ovarian cancer; and (2) assess and compare symptoms experienced by women diagnosed with ovarian cancer to women that have not been diagnosed with any type of cancer. The symptoms were identified by forty-seven (47) International Classification of Disease, 9th revision (ICD-9), diagnosis codes and categorized into four primary groups: (i) abdominal-pelvis; (ii) bladder; (iii) digestive; and (iv) pain. In conjunction with identifying the type of symptoms experienced, reoccurrence and combination of symptoms were also analyzed. The data to support this study was derived from health insurance claims between 2008 through 2013 from a commercial payer. All subjects for both studies were residents in the state of Texas and were a minimum of 24 years old. The analysis of the first aim of the study was primarily descriptive to assess symptoms and frequencies experienced prior to diagnosis. Of the 3,601 women diagnosed with ovarian cancer, 2,292 (64%) experienced a related symptom prior to or at diagnosis. Over 60% (n=1544) of women experienced a first symptom associated with abdomen and pelvis and 85% of overall complaints were associated with this group of symptoms. Pain was the second most frequent complaint at 45%, followed by digestive at 24% and bladder at 18%. This was also confirmed in women who experienced a combination of symptoms where abdomen and pelvis along with pain was shown to be the highest complaint at 41%. The results of the first study consequently led to pursue the second aim which included a nested case control study comparing a subset of 789 women diagnosed with ovarian cancer to women who did not have any history of cancer. The results supported statistical significance in symptoms experienced specific to abdomen and pelvis in conjunction with pain as well as digestive. While these symptoms are ordinary and are difficult to distinguish as having an association with ovarian cancer, the findings of this research appear to affirm that a symptom index may prove to be a useful method when recurring complaints are presented in women.