Chemotherapy delay after primary debulking surgery for ovarian cancer

Brandon Luke L Seagle, Sharlay K. Butler, Anna E. Strohl, Wilberto Nieves-Neira, Shohreh Shahabi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)260-265
Number of pages6
JournalGynecologic Oncology
Volume144
Issue number2
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

Fingerprint

Ovarian Neoplasms
Drug Therapy
Survival
Neoplasms
Insurance Coverage
Kaplan-Meier Estimate
Survival Analysis
Platinum
Cohort Studies
Logistic Models
Databases
Guidelines
Confidence Intervals
Population

Keywords

  • Chemotherapy
  • Ovarian cancer
  • Prognosis
  • Survival
  • Treatment Delay

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Seagle, B. L. L., Butler, S. K., Strohl, A. E., Nieves-Neira, W., & Shahabi, S. (2017). Chemotherapy delay after primary debulking surgery for ovarian cancer. Gynecologic Oncology, 144(2), 260-265. https://doi.org/10.1016/j.ygyno.2016.11.022

Chemotherapy delay after primary debulking surgery for ovarian cancer. / Seagle, Brandon Luke L; Butler, Sharlay K.; Strohl, Anna E.; Nieves-Neira, Wilberto; Shahabi, Shohreh.

In: Gynecologic Oncology, Vol. 144, No. 2, 01.02.2017, p. 260-265.

Research output: Contribution to journalArticle

Seagle, BLL, Butler, SK, Strohl, AE, Nieves-Neira, W & Shahabi, S 2017, 'Chemotherapy delay after primary debulking surgery for ovarian cancer', Gynecologic Oncology, vol. 144, no. 2, pp. 260-265. https://doi.org/10.1016/j.ygyno.2016.11.022
Seagle BLL, Butler SK, Strohl AE, Nieves-Neira W, Shahabi S. Chemotherapy delay after primary debulking surgery for ovarian cancer. Gynecologic Oncology. 2017 Feb 1;144(2):260-265. https://doi.org/10.1016/j.ygyno.2016.11.022
Seagle, Brandon Luke L ; Butler, Sharlay K. ; Strohl, Anna E. ; Nieves-Neira, Wilberto ; Shahabi, Shohreh. / Chemotherapy delay after primary debulking surgery for ovarian cancer. In: Gynecologic Oncology. 2017 ; Vol. 144, No. 2. pp. 260-265.
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abstract = "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.",
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