TY - JOUR
T1 - Treatment patterns, outcomes, and costs for bowel obstruction in ovarian cancer
AU - Suidan, Rudy S.
AU - He, Weiguo
AU - Sun, Charlotte C.
AU - Zhao, Hui
AU - Ramondetta, Lois M.
AU - Badgwell, Brian D.
AU - Bodurka, Diane C.
AU - Lu, Karen H.
AU - Giordano, Sharon H.
AU - Meyer, Larissa A.
N1 - Publisher Copyright:
Copyright © 2017 by IGCS and ESGO.
PY - 2017
Y1 - 2017
N2 - Objective: The aim of this study was to assess treatment patterns, outcomes, and costs for bowel obstruction in ovarian cancer. Methods/Materials: All patients with stage II to IV ovarian cancer who were admitted for bowel obstruction greater than or equal to 6 months after cancer diagnosis from 2000 to 2011 were identified from the Surveillance, Epidemiology, and End Results registry-Medicare database. Management strategies and outcomes of bowel obstruction were compared. Results: Among 1397 women with bowel obstruction, 562 (40%) underwent surgery, and 154 (11%) had a gastrostomy or jejunostomy (G/J) tube placed. Thirty-four percent of patients who underwent surgery subsequently received chemotherapy, compared with 8% of those managed with a G/J tube (odds ratio, 4.8; 95% confidence interval [CI], 2.7-8.8). Thirty-day complications were higher for patients in the surgery group compared with those in the tube group (69%vs 46%; odds ratio, 2.5; 95%CI, 1.8-3.7), asweremean adjusted 30-day total costs ($28,872 vs $18,528, P < 0.001). Median survivalwas greater forwomenwho underwent surgery compared with those who had a G/J tube (5.3 vs 1.2 months; adjusted hazard ratio, 0.31; 95% CI, 0.25-0.38). Themedian survival of patients in whom surgical correction failed and required G/J tube placement during the same inpatient admission was 2.6 months. Women who received postintervention chemotherapy had improved survival compared with thosewho did not in both the surgery (17.0 vs 2.8 months, P < 0.001) and G/J tube (5.7 vs 1.0 months, P < 0.001) groups. Conclusions: In women with ovarian cancer who develop bowel obstruction, surgery may benefit a subset of patients, likely related to the ability to receive subsequent chemotherapy. Efforts to identify thosewho derive no benefitmay reduce unnecessary laparotomy, along with its associated complications and costs. Given this population's limited survival, patient preferences should be evaluated in future studies assessing the management of bowel obstruction.
AB - Objective: The aim of this study was to assess treatment patterns, outcomes, and costs for bowel obstruction in ovarian cancer. Methods/Materials: All patients with stage II to IV ovarian cancer who were admitted for bowel obstruction greater than or equal to 6 months after cancer diagnosis from 2000 to 2011 were identified from the Surveillance, Epidemiology, and End Results registry-Medicare database. Management strategies and outcomes of bowel obstruction were compared. Results: Among 1397 women with bowel obstruction, 562 (40%) underwent surgery, and 154 (11%) had a gastrostomy or jejunostomy (G/J) tube placed. Thirty-four percent of patients who underwent surgery subsequently received chemotherapy, compared with 8% of those managed with a G/J tube (odds ratio, 4.8; 95% confidence interval [CI], 2.7-8.8). Thirty-day complications were higher for patients in the surgery group compared with those in the tube group (69%vs 46%; odds ratio, 2.5; 95%CI, 1.8-3.7), asweremean adjusted 30-day total costs ($28,872 vs $18,528, P < 0.001). Median survivalwas greater forwomenwho underwent surgery compared with those who had a G/J tube (5.3 vs 1.2 months; adjusted hazard ratio, 0.31; 95% CI, 0.25-0.38). Themedian survival of patients in whom surgical correction failed and required G/J tube placement during the same inpatient admission was 2.6 months. Women who received postintervention chemotherapy had improved survival compared with thosewho did not in both the surgery (17.0 vs 2.8 months, P < 0.001) and G/J tube (5.7 vs 1.0 months, P < 0.001) groups. Conclusions: In women with ovarian cancer who develop bowel obstruction, surgery may benefit a subset of patients, likely related to the ability to receive subsequent chemotherapy. Efforts to identify thosewho derive no benefitmay reduce unnecessary laparotomy, along with its associated complications and costs. Given this population's limited survival, patient preferences should be evaluated in future studies assessing the management of bowel obstruction.
KW - Bowel obstruction
KW - Gastrostomy tube
KW - Ovarian cancer
KW - Surgery
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85041680517&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041680517&partnerID=8YFLogxK
U2 - 10.1097/IGC.0000000000000998
DO - 10.1097/IGC.0000000000000998
M3 - Article
C2 - 28574929
AN - SCOPUS:85041680517
SN - 1048-891X
VL - 27
SP - 1350
EP - 1359
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 7
ER -