Socioeconomic factors may contribute to neoadjuvant chemotherapy use in metastatic epithelial ovarian carcinoma

Dana M Chase,Alejandrina Rincon,Molly Deane,Krishnansu S Tewari,Wendy R Brewster

doi:10.1016/j.ygyno.2009.08.008

Abstract

Objective. To identify patient characteristics which predict receipt of neoadjuvant chemotherapy (NCT) versus standard therapy (ST) in metastatic ovarian cancer. Methods. A retrospective matched case control study was conducted of 52 women treated with NCT compared to 104 women who received standard treatment from 1996 to 2007. The t test was used for comparison of means between the groups, and the χ 2 test was used for categorical data. Multivariable analysis was performed with logistic regression models and only two-tailed analyses with a P value < 0.05 were considered statistically significant. Results. Age, employment and marital status, and insurance alone did not affect treatment allocation ( P = NS). However, non-Hispanic White (NHW) patients were more as likely to receive ST ( P < 0.05). When insurance was stratified by ethnicity, NHW patients were twice as likely to have private insurance (OR = 2.29, CI = 1.16–4.53). Furthermore, medically compromised (MC) patients who were NHW were almost three times more likely to receive ST (OR = 2.72, CI = 1.02–5.00). In multivariate analysis, only MC and publically funded women were more likely to receive NCT (OR 3.83 CI = 1.35–11.11); P = 0.01). During surgery, patients receiving NCT were found to have smaller tumors and less ascites, and were more likely to be optimally debulked with lower estimated blood loss and shorter hospital stays. The median survival for ST was 55.8 months versus 26 months for NCT ( P < 0.001). Conclusions. Non-clinical factors such as publically funded status and non-Hispanic White race may influence the allocation of NCT for women with metastatic ovarian cancer.

Highlights

Ovarian cancer is the 5th leading cause of cancer death in women in the United States and there will be approximately 21,650 new cases and 15,520 deaths in 2009 [21]
Charlson Comorbidity Index (CCI) = Sum of points tallied above + 1 point for each decade above 50 years
Data were collected on a total of 156 patients. 104 patients who had received standard treatment were matched two to one with 52 patients who received neoadjuvant chemotherapy (NCT) based on date of initial treatment

Summary

Introduction

Ovarian cancer is the 5th leading cause of cancer death in women in the United States and there will be approximately 21,650 new cases and 15,520 deaths in 2009 [21]. The challenge of treating ovarian cancer is that 75% of women are diagnosed at an advanced stage [1]. Most of these women are postmenopausal and often have numerous associated co-morbidities [2]. Surgery can be complicated for this group and 70% are optimally debulked [3]. While the standard treatment of ovarian cancer is maximum cytoreductive surgery followed by adjuvant platinum-based chemotherapy, neoadjuvant chemotherapy (NCT) is a second option for some patients. The rationale behind the use of NCT is that patients will tolerate chemotherapy better if given prior to aggressive surgery and that pre-operative chemotherapy will reduce tumor volume facilitating optimal debulking and resulting

Methods

Results

Conclusion