Use Of Chemotherapy In Women Research Articles

Real-world impact of TAILORx on chemotherapy use and SOFT/TEXT on ovarian function suppression uptake in a population based-cohort of women 40 years and under with HR-positive, HER2-negative, axillary lymph node negative breast cancer.

534 Background: Gene expression profiling (GEP) testing is prognostic for distant recurrence risk in women with hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-), axillary lymph node negative (LN-) breast cancer (BC). The TAILORx trial generated prospective evidence demonstrating the 21-gene recurrence score (RS) is also predictive of chemotherapy (CT) benefit. The literature suggests that GEP testing reduces adjuvant CT prescription and is cost-effective. In the same era, the SOFT/TEXT trials demonstrated disease-free survival benefit for the addition of ovarian function suppression (OFS) to endocrine therapy in premenopausal women. Real-world uptake and impact of these advances in the management of HR+, HER2-, LN- BC in young women may be limited due to complex reasons. This retrospective study evaluated GEP and CT use post TAILORx and OFS use post SOFT/TEXT in women 40 years old or younger diagnosed with HR+, HER2-, LN BC from 2011 to 2020 in Alberta, Canada. Methods: Clinical variables were retrieved from the Alberta Health Services Cancer Care Breast Data Mart and through review of the electronic medical record. GEP testing and CT use were compared between 3 cohorts of women defined by diagnosis: pre RS funding/pre TAILORx (before April 2014), post RS funding/pre TAILORx (April 2014-May 2018), post TAILORx (June 2018 and beyond). OFS use was compared between 2 cohorts of women defined by diagnosis pre- and post SOFT/TEXT (May 2015). In subgroup analyses, we compared CT use by GEP status and RS category and OFS use by CT status. Results: Among the 291 women identified, GEP testing increased by 37% post GEP funding (pre 2% vs. post 39%; P = < .0001) and by additional 15% post TAILORx (pre 39% vs. post 54%; P < .0001) whereas overall CT use declined by 15% post GEP funding (pre 85% vs. post 70%; P = .01) and by additional 16% post TAILORx (pre 70% vs. post 54%; P = .01). Although not significant, OFS use increased by 8% post SOFT/TEXT (pre 13% vs. post 21%; P = .08). In subgroup analyses, post TAILORx was associated with a significant reduction in CT use of 19.5% in non-GEP tested women (pre 85% vs. post 65% P = .01) and non-significant increase in CT use of 6% in RS tested women (pre 40% vs. post 46%; P = .61) mainly driven by high mid range RS 21-25 and lower high range RS 26-30. There was no significant change in OFS use in non-CT treated women post SOFT/TEXT (Pre 5.3% vs. Post 8%, P = .68) whereas OFS use increased by 15% in women treated with CT post SOFT/TEXT (pre 15% vs. post 30%; P = .01). Conclusions: Public GEP funding and TAILORx led to widespread adoption of GEP and real-world decline in CT use in women 40 years of age or younger diagnosed with HR+, HER2-, LN- BC in Alberta. SOFT/TEXT led to real-world incline in OFS use in those treated with CT but adoption remained suboptimal.

Patterns of chemotherapy use in women with recurrent endometrial cancer (582)

Objectives: Recurrent endometrial cancer has a poor prognosis. The optimal treatment regimen in this setting remains unclear. The objective of this study was to describe patterns of utilization of cytotoxic, hormonal, and immunotherapy in women with endometrial cancer in the adjuvant setting and at the time of the first recurrence. Methods: A retrospective cohort study using the IBM MarketScan database was performed. We identified commercially insured women with endometrial cancer who underwent hysterectomy between 2011 and 2019, with or without adjuvant treatment. The use of clinically relevant therapeutic agents and those that were utilized in >2% of the cohort, as well as combination regimens, were determined in the adjuvant setting and at the time of the first recurrence. Recurrence was defined based on the introduction of a new agent or a gap of greater than three months from adjuvant therapy, or based on the initiation of chemotherapy more than 180 days after hysterectomy, for patients who did and did not receive adjuvant chemotherapy, respectively. Results: A total of 21,327 patients were identified. Of these, 6,828 (32.0%) received adjuvant radiation therapy, and 4,189 (19.6%) received adjuvant chemotherapy (78.2% of whom also received radiation). Of those who received adjuvant chemotherapy, the most commonly utilized agents were carboplatin (90.5%), paclitaxel (85.8%), cisplatin (9.4%), docetaxel (9.3%), gemcitabine (3.8%), and doxorubicin (2.1%), while bevacizumab was utilized in 1.5% of patients. A combination of platinum and a taxane was utilized as adjuvant therapy in 88.9% of women. Therapy for recurrent endometrial cancer was initiated in 1,707 patients (8.0% of the entire cohort). The median time from hysterectomy to initiation of chemotherapy for recurrence was 13.3 months (IQR: 7.6 to 23.0 months). Overall, platinum and taxane combination therapy was used in 747 (49.2%) patients, platinum alone or with other drugs in 186 (12.2%), and taxanes alone or with other drugs in 135 (8.9%). Non-platinum/non- taxane cytotoxic therapy was started in 236 (15.5%) patients, while 130 (8.6%) were treated with hormonal therapy and 24 (1.6%) with immunotherapy. While most patients who had not received adjuvant therapy also received platinum-based therapy, they were more likely than those who received adjuvant therapy to receive non-platinum- based regimens and hormonal therapy. Conclusions: Among women with endometrial cancer who underwent a hysterectomy, platinum-taxane combination chemotherapy was used in almost 90% of patients as adjuvant therapy while nearly 70% of women were treated with platinum or taxane-based therapy at first recurrence. Objectives: Recurrent endometrial cancer has a poor prognosis. The optimal treatment regimen in this setting remains unclear. The objective of this study was to describe patterns of utilization of cytotoxic, hormonal, and immunotherapy in women with endometrial cancer in the adjuvant setting and at the time of the first recurrence. Methods: A retrospective cohort study using the IBM MarketScan database was performed. We identified commercially insured women with endometrial cancer who underwent hysterectomy between 2011 and 2019, with or without adjuvant treatment. The use of clinically relevant therapeutic agents and those that were utilized in >2% of the cohort, as well as combination regimens, were determined in the adjuvant setting and at the time of the first recurrence. Recurrence was defined based on the introduction of a new agent or a gap of greater than three months from adjuvant therapy, or based on the initiation of chemotherapy more than 180 days after hysterectomy, for patients who did and did not receive adjuvant chemotherapy, respectively. Results: A total of 21,327 patients were identified. Of these, 6,828 (32.0%) received adjuvant radiation therapy, and 4,189 (19.6%) received adjuvant chemotherapy (78.2% of whom also received radiation). Of those who received adjuvant chemotherapy, the most commonly utilized agents were carboplatin (90.5%), paclitaxel (85.8%), cisplatin (9.4%), docetaxel (9.3%), gemcitabine (3.8%), and doxorubicin (2.1%), while bevacizumab was utilized in 1.5% of patients. A combination of platinum and a taxane was utilized as adjuvant therapy in 88.9% of women. Therapy for recurrent endometrial cancer was initiated in 1,707 patients (8.0% of the entire cohort). The median time from hysterectomy to initiation of chemotherapy for recurrence was 13.3 months (IQR: 7.6 to 23.0 months). Overall, platinum and taxane combination therapy was used in 747 (49.2%) patients, platinum alone or with other drugs in 186 (12.2%), and taxanes alone or with other drugs in 135 (8.9%). Non-platinum/non- taxane cytotoxic therapy was started in 236 (15.5%) patients, while 130 (8.6%) were treated with hormonal therapy and 24 (1.6%) with immunotherapy. While most patients who had not received adjuvant therapy also received platinum-based therapy, they were more likely than those who received adjuvant therapy to receive non-platinum- based regimens and hormonal therapy. Conclusions: Among women with endometrial cancer who underwent a hysterectomy, platinum-taxane combination chemotherapy was used in almost 90% of patients as adjuvant therapy while nearly 70% of women were treated with platinum or taxane-based therapy at first recurrence.

Chemotherapy refusal and subsequent survival in older women with high genomic risk, estrogen receptor–positive breast cancer.

520 Background: Patients with estrogen receptor (ER)- positive breast cancer and high-risk 21-gene recurrence score (RS) assay results benefit from chemotherapy, however some patients choose to decline chemotherapy. We evaluated factors associated with chemotherapy refusal by older women with high RS breast cancer and investigated the association of chemotherapy refusal with mortality. Methods: We used the National Cancer Database (2010-2017) to retrospectively identify women aged ≥65 years with ER-positive, HER2-negative, high RS (≥26) breast cancer. Women with Charlson Comorbidity Index ≥1, stage III or IV disease, or any unknown variables were excluded. Women with high RS who refused chemotherapy were compared to women with high RS who received chemotherapy. Refusal trends were analyzed using the Cochrane Armitage test. Factors associated with chemotherapy refusal were evaluated with a multivariable regression model. Overall survival (OS) by age and by treatment were evaluated with Kaplan-Meier and Cox proportional hazards modeling. Results: 6827 women met study criteria; 5449 (80%) received chemotherapy and 1378 (20%) refused. Relative to those who received chemotherapy, those who refused chemotherapy were older (median age 71 vs 69 years; p < 0.05), more often insured with Medicare (83% vs 80%; p = 0.05), were diagnosed more recently (2014-2017 vs 2010-2013, 67% vs 61%; p < 0.05), had lower grade tumors (grade 1 or 2 vs grade 3, 57% vs 48%; p < 0.05), more frequently had progesterone receptor-positive tumors (68% vs 63%; p < 0.05), and received radiation less frequently (67% vs 71%; p < 0.05). Chemotherapy refusal was significantly associated with increasing age (age 75-79 vs 65-74 OR 1.61, CI 1.4-1.85; age ≥80 vs 65-74 OR 3.24, CI 2.76-3.79) and more recent year of diagnosis (2014-2017 vs 2010-2013; OR 1.3 CI 1.14-1.48). Chemotherapy refusal was significantly associated with decreased 5-year OS for patients aged 65-74 years (92% vs 95%; p < 0.05) and patients aged 75-79 years (85% vs 92%; p < 0.05), but not for those aged ≥80 years (84% vs 91%; p = 0.07). Overall, when controlling for patient factors, hazard of death with chemotherapy refusal was significantly increased (HR 1.12, CI 1.04-1.2), but was not increased for women aged ≥80 years when stratified by age. Conclusions: Among healthy women aged ≥65 with high genomic risk ER-positive breast cancer, chemotherapy refusal increased with increasing age. Chemotherapy refusal was significantly associated with decreased OS in women aged 65-79, but did not impact OS in women aged ≥80. Lower use of chemotherapy in women ≥80 may demonstrate pragmatic decision-making between physicians and patients. Furthermore, the routine use of genomic assays may not be appropriate in this age group. More research is needed to determine why women aged 65-79 refuse chemotherapy, and whether patients remain satisfied with these choices.

Impact of the COVID-19 Pandemic on Breast Cancer Mortality in the US: Estimates From Collaborative Simulation Modeling.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. MethodsThree established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact.ResultsBy 2030, the models project 950 (model range = 860-1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266-1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146-207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713-2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic’s disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months.ConclusionsInitial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.

Chemotherapy and the recurrence score--results as expected?

A study assessing the impact of the 21-gene recurrence score assay in routine clinical practice on the use of adjuvant chemotherapy in women with early stage ER-positive breast cancers showed that adjuvant chemotherapy use decreased in high-risk patients, but increased in low-risk patients. I discuss these results and highlight how this reflects more-selective administration of chemotherapy.

Abstract P3-07-22: Predictors of neoadjuvant chemotherapy use in women with breast cancer: A review of 169,329 patients from the American College of Surgeons' National Cancer Database

Abstract Background: Randomized controlled trials have demonstrated that neoadjuvant chemotherapy (NAC) offers equivalent long-term outcomes when compared to adjuvant chemotherapy while improving rates of breast conservation therapy (BCT). We sought to evaluate the national use of NAC and the patient, tumor, and provider characteristics associated with its use among women with stage I-III breast cancer. We hypothesize that younger women with larger tumors and HER-2+ or triple negative disease are more likely to receive NAC than their older counterparts with ER+ disease, and that use of NAC varies by region and practice setting. Methods: Using the American College of Surgeons National Cancer Database, which captures data on approximately 70% of new cancer diagnoses in the U.S., we identified women with diagnosed with stage I-III invasive cancer between 2008-2013. Women treated with both surgery and chemotherapy were included in the study. Demographic and clinical factors including race, ethnicity, income, insurance type, region of treatment facility, treatment facility type, tumor size, hormone receptor status, HER-2 status and Charlson Comorbidity score were analyzed to determine predictors associated with receipt of NAC. Utilization of preoperative chemotherapy and rates of breast conserving therapy (BCT) were evaluated as outcomes. Results: 169,329 women with stage I-III breast cancer underwent treatment with chemotherapy and surgery during the study period. Of these, 81.0% were White, 14.4% were Black, 4.6% were classified as Other Race. 28.7% were 18-49, 46.8% were 50-64 and 24.5% were >65 years. 64.4% had private insurance while 35.6% had public insurance (Medicaid, Medicare and VA), and 71.4% were treated at Community-Based Clinics while 28.6% were treated at Academic Medical Centers. Patients with larger tumors (p<0.0001) and triple negative disease were significantly more likely to be treated with NAC than those with ER+ or HER2+ disease (p<0.0001). Among women who received NAC, the median age was 54 as compared to 57 in those receiving adjuvant chemotherapy (p<0.0001). Treatment facility type impacted rates of NAC use, with academic centers being more likely than community-based practices to give chemotherapy preoperatively (12.1% vs. 9.8%, p<0.0001) and urban vs. rural settings (10.4% vs 8.2%, p<0.0001). Rates of NAC utilization differed regionally with the highest rate being 14.0% and the lowest rate 7.9% (p<0.0001). The overall % of BCT following NAC was 36.1% compared to 59.0% for those receiving adjuvant chemotherapy. The proportion of BCT following NAC differed significantly by subtype, 54.6% for ER+, 54.5% for Her2 +, and 59.7% for triple negative breast cancer (TNBC) (p <0.0001). Conclusions: In the treatment of stage I-III breast cancer across the US, variations in the utilization of neoadjuvant chemotherapy exist across the country suggesting clinical uncertainty about its use. Further research about the use of NAC therapy and the relationship to clinical outcomes can identify patient subsets who might obtain greatest clinical benefit from preoperative systemic therapy. Citation Format: Lynn J Howie, Rachel Greenup, Kevin Houck, Julie A Sosa, E Shelley Hwang, Jeffrey M Peppercorn. Predictors of neoadjuvant chemotherapy use in women with breast cancer: A review of 169,329 patients from the American College of Surgeons' National Cancer Database [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-07-22.

Abstract P1-09-04: Use of adjuvant chemotherapy and outcomes in women 70 years and older with HER-2 positive or triple negative breast cancer

Abstract Background: Chemotherapy use decreases with increasing age. There is a stronger rationale for adjuvant chemotherapy in HER-2 positive (HER2+) and triple negative (TN) breast cancer (BC) due to a higher risk of recurrence, known benefit of trastuzumab with chemotherapy and lack of other systemic options. Aims: 1) Compare outcomes of resected HER2+ and TN BC in older women (age ≥70) (OW) vs. younger women (age 50-69) (YW) 2) Determine chemotherapy use in OW vs. YW 3) Explore factors associated with chemotherapy use in women with HER2+ and TN BC and determine how these factors differ by age group (OW vs. YW) Methods: Women ≥50 years old with newly diagnosed resected HER2+ or TN stage I-III BC in British Columbia from 2003-2006 were included. Data on comorbidity, performance status, and reason for no chemotherapy was gathered via chart review of OW. Kaplan-Meier curves for relapse-free survival (RFS), breast cancer-specific survival (BCSS) and overall survival (OS) were calculated. Logistic regression was used to model the likelihood of receiving chemotherapy and Cox proportional hazards was used to model BCSS and OS. Results: OW (n = 292) had larger tumors (p = 0.002), more often had mastectomy and less often had adjuvant radiation (p<0.001) than YW (n = 946). There were no differences in nodal or receptor status. OW vs. YW were less likely to receive chemotherapy (28.1 vs. 81.3%, p<0.001); odds decreased with increasing age (OR 15.9 and 7.4 for women age 50-59 and 60-69 vs. ≥70, p<0.001). Odds of receiving chemotherapy were higher in women with HER2+, ER/PR negative tumours than those with HER2+, ER/PR positive (OR 2.2) and TN tumours (OR 1.7) (p = 0.004). Some factors associated with chemotherapy use differed between YW and OW: tumour size (T2 vs. T1, OR 2.6, p = 0.059) and grade (high grade vs. low grade, OR 6.5, p = 0.02) were only associated with chemotherapy use in YW. OW with more comorbid conditions (CCI≥2) were less likely to receive chemotherapy than those with zero or one comorbid condition (OR 5.0 and 2.7 respectively, p = 0.009). In OW, reasons cited for not administering chemotherapy included: patient refusal (45.2%), patient age (38.1%), perceived minimal benefit (36.7%), patient comorbidity (28.6%), and concern about chemotherapy toxicity (28.6%). Chemotherapy was not mentioned in almost 1 in 5 cases (17.6%). OW had worse 5-year RFS (75.4 vs. 83.2%, p = 0.002), BCSS (79.5 vs. 88.1%, p<0.001) and OS (63.7 vs. 85.8%, p<0.001). After adjusting for known prognostic factors and treatment differences, increasing age was still significantly associated with poorer 5-year OS (HR 1.2, p = 0.003), but not with BCSS after adjusting for the competing risk of non-BC deaths. 5-year OS, but not BC-specific outcomes (RFS, BCSS), was significantly better in those who received chemotherapy compared to those who did not. Conclusion: OW with HER2+/TN BC are less likely to receive adjuvant chemotherapy than YW. Factors associated with chemotherapy receipt differ in OW, with tumor size and grade only being influential in YW. Age was only independently associated with OS and not BCSS, suggesting inferior BCSS rates in OW may be due to the presence of larger tumors or differences in treatments received by OW. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-04.

The Evolving Role of Adjuvant Chemotherapy.

Abstract Decision-making for the medical oncologist was once far simpler than it is today. Following the 2000 NIH Consensus Conference on the treatment of early stage breast, almost all women with tumors > 1cm or positive lymph nodes were offered a course of adjuvant chemotherapy. There were some choices to be made in terms of the specific adjuvant regimen, but the oncologist could rely upon the results of large, randomized trials and choose a regimen that had been shown to be beneficial. Indeed, some might argue that a medical oncologist in 2009 could take the same approach. But the breast cancer world has evolved substantially over the past 5-7 years, and such an approach would not take full advantage of our understanding of breast cancer in 2009. We now understand that there is a great degree of intrinsic heterogeneity across breast tumors, and that the benefits associated with adjuvant chemotherapy vary substantially by subtype of disease. At minimum, we should consider three groups of patients separately: 1) individuals with HER2 positive disease; 2) individuals with triple negative disease; and 3) individuals with ER+ and HER2 non-amplified, non-overexpressed disease, who represent the vast majority of the patients with breast cancer in the United States. For patients with HER2+ disease, trastuzumab-based therapy has become the standard of care for all but women who have very small (T1a) tumors in the setting of negative lymph. Even in those women, there are physicians who would recommend a course of adjuvant trastuzumab-based chemotherapy. The major question is what chemotherapy to use in combination with trastuzumab, and this is a matter of considerable debate. In addition, uncertainty exists surrounding the optimal treatment for individuals who have indeterminate HER2 test results. For women with triple negative breast cancer, chemotherapy is also given to almost all patients apart from those with the very smallest tumors in the context of negative lymph nodes. For most patients, one of the standard anthracycline-taxane regimens remains the usual course of therapy. For patients with a low disease burden, first or second generation regimens such as AC, TC, or CMF are reasonable considerations. The most difficult questions arise concerning the use of chemotherapy in women with ER+ and HER2 normal disease. In this setting, the average benefit associated with chemotherapy is far less than in women with HER2+ or triple negative disease. Recent retrospective studies suggest that there are large groups of women who likely derive almost no or almost no benefit from chemotherapy. Increasingly, assays such as the Oncotype Dx Recurrence Score are used to aid clinical decisions, but even these complex genetic assays do not always provide a clear roadmap. Controversies and practical considerations surrounding the use of chemotherapy in women with ER+ and HER2 normal disease will be discussed in detail. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr CS1-2.

Patient preference as a determinant of breast cancer adjuvant chemotherapy use in older women: CALGB #369901

9544 Background: Decisions about use of breast cancer chemotherapy in women 65 and older (“older”) can be complex due to comorbidity, uncertain efficacy and limited data on patient preference. Methods: Older women diagnosed with invasive, non-metastatic breast cancer between 2004 and 2008 were recruited from 53 CALGB sites for an observational study of preferences and chemotherapy use. Data on preferences and other factors were collected from patient interviews and clinical data were abstracted from charts. Generalized estimating equation regression was used to assess associations between chart-reported chemotherapy and independent variables; associations were also evaluated in 2 subgroups: “chemotherapy indicated” (estrogen receptor [ER] negative and/or node positive) and “consider chemotherapy” (ER positive and node negative). Results: Among 935 eligible women registered, 815 (87.2%) completed interviews. The mean age of the cohort was 73 years (range 65–100); 38% were node positive, 82% were ER positive and all had tumors ≥ 1 cm (44% were AJCC stage 1, 44% stage 2 and 12% stage 3). Based on ER and nodal status, chemotherapy was “indicated” for 47% and could be “considered” for 53%. Crude chemotherapy rates were 70% in the “indicated” group and 17% in the “considered” group, for an overall rate of 42%. Women who would choose chemotherapy for an increase in survival of ≤12 months were 4.1 times (95% CI 2.5–6.7, p<.0001) more likely to receive chemotherapy than women who would only choose chemotherapy if it added more than 12 months, controlling for age, tumor factors, comorbidity and other covariates. Stronger preferences were seen among women with “indications” for chemotherapy (OR 7.9, 95% CI 3.7–17.0, p<.001) than in those where treatment might be “considered” (OR 1.8, 95% CI 0.9–3.4, p=.08). Higher patient rating of communication with providers was independently related to a decision to use chemotherapy among women where chemotherapy could be “considered” but not among those where chemotherapy was “indicated”. Conclusions: Beyond clinical indications, older women's preferences and communication with providers are important correlates of chemotherapy use. [Table: see text]

Practice patterns of intraperitoneal chemotherapy in women with ovarian cancer

Objectives To determine the current patterns of IP chemotherapy use in women with ovarian cancer. Methods A survey concerning the use of intraperitoneal (IP) chemotherapy was sent to all members of the SGO listed in the 2005 SGO directory and to 200 members of ASCO randomly selected from the ASCO directory in two mailings. Results There were 209 completed responses to the survey, which included 24% of the SGO and 3% of the ASCO members sampled ( P < 0.0001). Of the respondents, 77% indicated that they currently offer IP chemotherapy, 14% either refer patients, or plan to offer IP chemo in the near future, and 9% do not offer IP chemotherapy. The top reasons given by those not using IP chemo was toxicity (63%) and not having the facilities to give an IP infusion (16%). Significant concern over toxicity by all respondents was highest for neurological toxicity (55%) followed by nausea and vomiting (51%), catheter infections (39%) and nephropathy (39%). The most common dose of IP cisplatin was 75 mg/m 2 (54%), followed by 100 mg/m 2 (38%). Only 6% use carboplatin primarily, but 60% reduce the cisplatin dose based on age. Currently 58% have modified the paclitaxel infusion to allow administration of this regimen in the outpatient setting and 17% plan to do so in the near future. Those using lower doses of platinum are also more likely to offer chemotherapy in the outpatient setting. Concern over toxicity, lack of coverage by residents or fellows, or type of practice did not predict a reduction in platinum dose. A single lumen IP catheter was used by 60% of respondents and a fenestrated is preferred by 40%. This catheter is placed at the time of primary surgery by 58% and 37% routinely place the catheter during a second procedure. Conclusion The toxicity of IP therapy remains a concern and there does not appear to be any standard IP regimen that is used in women with ovarian cancer. The majority of the SGO members give IP chemotherapy in an outpatient setting at a dose lower than was used in clinical trials. This survey probably represents an overestimate in the use of IP therapy as there is likely a bias in completing the survey by those who currently use this modality. Based on this assumption, it appears that the use of IP chemotherapy by medical oncologists is low.

Patterns and outcomes of chemotherapy for elderly patients with stage II ovarian cancer: a population-based study

Background. The optimal treatment for patients with stage II ovarian cancer is controversial, although most experts recommend adjuvant chemotherapy. The purpose of this study was to assess the patterns of use of chemotherapy in women with stage II ovarian cancer, and to compare the survival of treated and untreated patients aged 65+ years in a population-based sample. Methods. Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database of cancers diagnosed in approximately 14% of the U.S. population, we identified women who were diagnosed with stage II ovarian cancer between 1992 and 1996, survived ≥120 days beyond diagnosis, and were ≥65 years of age. Multivariate regression was used to compare those treated to those not treated with chemotherapy. Cox proportional hazards regression models were used to analyze patient survival. Results. Of 236 women with stage II ovarian cancer, 160 (67.8%) received chemotherapy, and 118 (50%) received platinum-based regimens. Younger patients and those with higher-grade tumors were more likely to receive chemotherapy. The adjusted hazards ratio for mortality associated with any chemotherapy use was 0.67 (95% CI, 0.45–0.98), corresponding to an increase in median survival from 28 months to 35 months ( P < 0.0001). Conclusions. This observational study found that most patients aged ≥65 years and diagnosed with stage II ovarian cancer between 1992 and 1996 were treated with chemotherapy. Grade and younger age were the most significant predictors of treatment, and treatment was associated with a 5-year mortality reduction of 33%. These findings are not definitive, but they may provide some guidance in the absence of randomized trials of adjuvant chemotherapy for older women with stage II ovarian cancer.

Correction: Discrepancy between Consensus Recommendations and Actual Community Use of Adjuvant Chemotherapy in Women with Breast Cancer

Correction: Discrepancy between Consensus Recommendations and Actual Community Use of Adjuvant Chemotherapy in Women with Breast Cancer

Patterns of use of chemotherapy for breast cancer in older women: findings from Medicare claims data.

There is little population-based information available on the use of chemotherapy in women with breast cancer. This study describes the use of chemotherapy through analysis of Medicare claims and determines the correlates of chemotherapy use. We used the merged Surveillance, Epidemiology, and End Results-Medicare database and identified women > or = 65 years of age diagnosed with breast cancer in 1991 and 1992. Chemotherapy was ascertained from Medicare claims through procedure codes for chemotherapy made within 24 months of the diagnosis. In women with stages I, II, III, and IV breast cancer, the percentage receiving chemotherapy within 24 months of diagnosis was 5.1%, 19.5%, 33.9%, and 35.2%, respectively. Most women receiving chemotherapy had two to 12 claims; the median number was eight. Use of chemotherapy decreased significantly with age across all tumor stages; eg, in women with stage III cancer, the use of chemotherapy declined from 49% in those aged 65 to 69 years to 10% in those > or = 80 years old. In a multivariate analysis, there was little variation by ethnicity. Chemotherapy use was highest (70%) in women aged 65 to 69 years with node-positive and estrogen receptor-negative tumors and lowest (5%) in those with node-negative and estrogen receptor-positive tumors. Compared with those without comorbid diseases, patients with a comorbidity score of 2 had significantly lower use of chemotherapy. Medicare claims data seem to provide valuable information on the use of chemotherapy for breast cancer in older women. However, external validation of the accuracy and completeness of these data is required before any firm conclusion can be drawn.