Factors associated with delivery of neoadjuvant chemotherapy in women with advanced stage ovarian cancer

Emily Hinchcliff*, Alexander Melamed, Amy Bregar, Elisabeth Diver, Joel Clemmer, Marcela Del Carmen, John O. Schorge, J. Alejandro Rauh-Hain

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)168-173
Number of pages6
JournalGynecologic oncology
Volume148
Issue number1
DOIs
StatePublished - Jan 2018
Externally publishedYes

Keywords

  • Care disparities
  • Neoadjuvant chemotherapy
  • Ovarian cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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