TY - JOUR
T1 - Factors associated with delivery of neoadjuvant chemotherapy in women with advanced stage ovarian cancer
AU - Hinchcliff, Emily
AU - Melamed, Alexander
AU - Bregar, Amy
AU - Diver, Elisabeth
AU - Clemmer, Joel
AU - Del Carmen, Marcela
AU - Schorge, John O.
AU - Alejandro Rauh-Hain, J.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - 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.
AB - 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.
KW - Care disparities
KW - Neoadjuvant chemotherapy
KW - Ovarian cancer
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U2 - 10.1016/j.ygyno.2017.10.038
DO - 10.1016/j.ygyno.2017.10.038
M3 - Article
C2 - 29128105
AN - SCOPUS:85033405144
SN - 0090-8258
VL - 148
SP - 168
EP - 173
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 1
ER -