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Showing content from https://pubmed.ncbi.nlm.nih.gov/29128105/ below:

Factors associated with delivery of neoadjuvant chemotherapy in women with advanced stage ovarian cancer

. 2018 Jan;148(1):168-173. doi: 10.1016/j.ygyno.2017.10.038. Epub 2017 Nov 8. Factors associated with delivery of neoadjuvant chemotherapy in women with advanced stage ovarian cancer

Affiliations

¹ Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA, United States. Electronic address: emhinchcliff@mdanderson.org.
² Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
³ Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States.

PMID: 29128105
DOI: 10.1016/j.ygyno.2017.10.038

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Factors associated with delivery of neoadjuvant chemotherapy in women with advanced stage ovarian cancer

Emily Hinchcliff et al. Gynecol Oncol. 2018 Jan.

. 2018 Jan;148(1):168-173. doi: 10.1016/j.ygyno.2017.10.038. Epub 2017 Nov 8. Affiliations

¹ Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA, United States. Electronic address: emhinchcliff@mdanderson.org.
² Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
³ Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States.

PMID: 29128105
DOI: 10.1016/j.ygyno.2017.10.038

Item in Clipboard

Abstract

Purpose: To identify clinical and non-clinical factors associated with utilization of primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy (NACT) in women with advanced stage epithelial ovarian cancer (EOC).

Methods: Using the National Cancer Database, we identified women with stage IIIC and IV EOC diagnosed from 2012 to 2014. The primary outcome was receipt of NACT, defined in the primary analysis as utilization of chemotherapy as the first cancer-directed therapy, irrespective of whether interval surgery was performed. Univariable and multivariable associations between clinical and non-clinical factors and receipt of NACT were investigated using mixed-effect logistic regression models. A secondary analysis excluded women who received primary chemotherapy but did not receive interval cytoreductive surgery.

Results: Among 17,302 eligible women, 10,948 (63.3%) underwent PCS and 6354 (36.7%) received NACT. Older age, stage IV disease, high-grade, and serous histology were associated with receipt of NACT in univariate (p<0.001) and multivariable analyses (p<0.001). Analysis of non-clinical factors revealed that residency in the Northeast region and receipt of treatment closer to home were associated with NACT in univariate (p<0.05) but not multivariable analysis (p>0.05). In multivariable analysis, African-American race/ethnicity (p=0.04), low-income level (p=0.02), treatment in high-volume centers (p<0.01), and insurance by Medicare or other government insurance (p<0.001) were associated with receipt of NACT. When women who received no surgery were excluded, all factors that were independent predictors of NACT in the main analysis remained significant, except for race/ethnicity.

Conclusions: Non-clinical factors were associated with the use of NACT at a magnitude similar to that of clinically relevant factors.

Keywords: Care disparities; Neoadjuvant chemotherapy; Ovarian cancer.

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