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Chemotherapy delay after primary debulking surgery for ovarian cancer
Highlights
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- Nearly 60% of women experience chemotherapy delay > 28 days.
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- Chemotherapy delay > 35 days is associated with a 7% increased hazard of death.
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- The evidence-based best surgery to chemotherapy interval is 21–35 days.
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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