TY - JOUR
T1 - Variability in chemotherapy delivery for elderly women with advanced stage ovarian cancer and its impact on survival
AU - Wright, J. D.
AU - Doan, T.
AU - McBride, R.
AU - Jacobson, J. S.
AU - Hershman, D. L.
N1 - Funding Information:
This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. We acknowledge the efforts of the Applied Research Branch, Division of Cancer Prevention and Population Science, NCI; the Office of Information Services, and the Office of Strategic Planning, HCFA; Information Management Services (IMS) Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. Dr Hershman is the recipient of an ASCO ACRA Award. Russell McBride is the recipient of an NCI R25 (CA94061), and a T32 (ULI RR024156) from the NIH-NCRR. Dr Neugut is the recipient of a grant from the American Cancer Society (RSGT-01-024-04-CPHPS).
PY - 2008/4/8
Y1 - 2008/4/8
N2 - Given the survival benefits of adjuvant chemotherapy for advanced ovarian cancer (OC), we examined the associations of survival with the time interval from debulking surgery to initiation of chemotherapy and with the duration of chemotherapy. Among patients ≥65 years with stages III/IV OC diagnosed between 1991 and 2002 in the Surveillance, Epidemiology, and End Results-Medicare database, we developed regression models of predictors of the time interval from surgery to initiation of chemotherapy and of the total duration of chemotherapy. Survival was examined with Cox proportional hazards models. Among 2558 patients, 1712 (67%) initiated chemotherapy within 6 weeks of debulking surgery, while 846 (33%) began treatment >6 weeks. Older age, black race, being unmarried, and increased comorbidities were associated with delayed initiation of chemotherapy. Delay of chemotherapy was associated with an increase in mortality (hazard ratio (HR)=1.11; 95% CI, 1.0-1.2). Among 1932 patients in the duration of treatment analysis, the 1218 (63%) treated for 3-7 months had better survival than the 714 (37%) treated for ≤3 months (HR=0.84; 95% CI, 0.75-0.94). This analysis represents one of the few studies describing treatment delivery and outcome in women with advanced OC. Delayed initiation and early discontinuation of chemotherapy were common and associated with increased mortality.
AB - Given the survival benefits of adjuvant chemotherapy for advanced ovarian cancer (OC), we examined the associations of survival with the time interval from debulking surgery to initiation of chemotherapy and with the duration of chemotherapy. Among patients ≥65 years with stages III/IV OC diagnosed between 1991 and 2002 in the Surveillance, Epidemiology, and End Results-Medicare database, we developed regression models of predictors of the time interval from surgery to initiation of chemotherapy and of the total duration of chemotherapy. Survival was examined with Cox proportional hazards models. Among 2558 patients, 1712 (67%) initiated chemotherapy within 6 weeks of debulking surgery, while 846 (33%) began treatment >6 weeks. Older age, black race, being unmarried, and increased comorbidities were associated with delayed initiation of chemotherapy. Delay of chemotherapy was associated with an increase in mortality (hazard ratio (HR)=1.11; 95% CI, 1.0-1.2). Among 1932 patients in the duration of treatment analysis, the 1218 (63%) treated for 3-7 months had better survival than the 714 (37%) treated for ≤3 months (HR=0.84; 95% CI, 0.75-0.94). This analysis represents one of the few studies describing treatment delivery and outcome in women with advanced OC. Delayed initiation and early discontinuation of chemotherapy were common and associated with increased mortality.
KW - Chemotherapy
KW - Duration of chemotherapy
KW - Ovarian cancer
KW - Treatment delay
UR - http://www.scopus.com/inward/record.url?scp=41649115608&partnerID=8YFLogxK
U2 - 10.1038/sj.bjc.6604298
DO - 10.1038/sj.bjc.6604298
M3 - Article
C2 - 18349836
AN - SCOPUS:41649115608
SN - 0007-0920
VL - 98
SP - 1197
EP - 1203
JO - British Journal of Cancer
JF - British Journal of Cancer
IS - 7
ER -