Chemotherapy delay after primary debulking surgery for ovarian cancer

Objective To determine the association of chemotherapy delay with overall survival (OS) and investigate predictors of delay among a population-representative American ovarian cancer cohort. Methods An observational retrospective cohort analysis of women with ovarian cancer who received National Comprehensive Cancer Network guideline-consistent care was performed with the 1998–2011 National Cancer Data Base. Chemotherapy delay was defined as initiation of multiagent chemotherapy > 28 days from primary debulking surgery. Associations of patient and disease characteristics with chemotherapy delay were tested with multivariate logistic regression. Survival analyses for women diagnosed from 2003 to 2006 approximated a 21-day cycle intravenous platinum-taxane chemotherapy cohort. Overall survival was estimated by Kaplan-Meier analyses and Cox proportional-hazards regressions, with sensitivity analyses using matched cohorts. Results 58.1% (26,149/45,001) of women experienced chemotherapy delay. Race, insurance status, cancer center type, and community median income were significantly associated with chemotherapy delay (P < 0.001). Odds for chemotherapy delay were higher for older or sicker women, women with endometrioid or mucinous histology, lower stage or grade disease, and uninsured or low-income women (P < 0.05). Chemotherapy delay > 35 days from surgery was associated with a 7% (95% confidence interval, 2–13%) increased hazard of death (P = 0.01). Relative hazard of death was lowest between 25 and 29 days after surgery but was not significantly different within the longer two-week interval from 21 to 35 days. Conclusion A survival benefit may be achieved by consistently starting chemotherapy between 21 and 35 days from primary debulking surgery. Women at higher risk for chemotherapy delay may be targeted for close follow-up.