Completion of Adjuvant Chemotherapy and Use of Health Services for Older Women With Epithelial Ovarian Cancer

Fairfield, Kathleen M.; Murray, Kimberly; Lucas, F. Lee; Wierman, Heidi R.; Earle, Craig C.; Trimble, Edward L.; Small, Laurie; Warren, Joan L.

doi:10.1200/jco.2010.34.1552

Cited by 57 publications

(30 citation statements)

References 23 publications

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“…Chemotherapy feasibility rates were consistent with previous studies, which ranged from 49.1% [19,20,23,43,[45][46][47][48] to 80% [49]. The highest feasibility rates were found in studies [19,20,49] that included only patients without metastases, whose functional status was probably better than in our population.…”

Section: Discussionsupporting

confidence: 79%

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Assessment of Solid Cancer Treatment Feasibility in Older Patients: A Prospective Cohort Study

Laurent

Paillaud

Tournigand³

et al. 2014

The Oncologist

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Purpose. To assess solid cancer treatment feasibility in older patients Methods. Between 2007 and 2010, 385 consecutive elderly patients (mean age: 78.9 6 5.4 years; 47.8% males) with solid malignancies referred to two geriatric oncology clinics were included prospectively. We recorded feasibility of first-line chemotherapy (planned number of cycles in patients without metastases and three to six cycles depending on tumor site in patients with metastases), surgery (patient alive 30 days after successfully performed planned surgical procedure), radiotherapy (planned dose delivered), and hormonal therapy (planned drug dose given), and we recorded overall 1-year survival. Results. Main tumor sites were colorectal (28.6%), breast (23.1%), and prostate (10.9%), and 47% of patients had metastases. Planned cancer treatment was feasible in 65.7% of patients with metastases; this proportion was 59.0% for chemotherapy, 82.6% for surgery, 100% for radiotherapy, and 85.2% for hormonal therapy. In the group without metastases, feasibility proportions were 86.8% overall, 72.4% for chemotherapy, 95.7% for surgery, 96.4% for radiotherapy, and 97.9% for hormonal therapy. Factors independently associated with chemotherapy feasibility were good functional

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Section: Discussionsupporting

confidence: 79%

“…Definitions of feasibility vary widely, particularly for surgery and chemotherapy [19,20,23,24,43,[45][46][47][48]. Surgery feasibility has been defined as successful completion of the planned surgical procedure, tumor-free resection margins, or absence of postoperative complications with survival on day 30.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Solid Cancer Treatment Feasibility in Older Patients: A Prospective Cohort Study

Laurent

Paillaud

Tournigand³

et al. 2014

The Oncologist

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“…1 However, older adults are less likely to receive the most effective cancer treatments 2 and to complete a standard course of chemotherapy (CTX). 3 To optimize the receipt of cancer treatments in older adults, a significant amount of research has focused on predictors of mortality, dose reductions, and other traditional treatment outcomes (for reviews see 4–7). While prediction of these treatment outcomes is important, 8 virtually nothing is known about the impact of CTX on older oncology patients’ functional status during the receipt of CTX.…”

Section: Introductionmentioning

confidence: 99%

Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy

Miaskowski

Wong

Cooper

et al. 2017

Journal of Pain and Symptom Management

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Context While physical function is an important patient outcome, little is known about changes in physical function in older adults receiving chemotherapy (CTX). Objectives Identify subgroups of older patients based on changes in their level of physical function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality of life (QOL) outcomes. Methods Latent profile analysis (LPA) was used to identify groups of older oncology patients (n=363) with distinct physical function profiles. Patients were assessed six times over two cycles of CTX using the Physical Component Summary (PCS) score from the SF12. Differences, among the groups, in demographic and clinical characteristics and quality of life (QOL) outcomes were evaluated using parametric and nonparametric tests. Results Three groups of older oncology patients with distinct functional profiles were identified: Well Below (20.4%), Below (43.8%), and Above (35.8%) normative PCS scores. Characteristics associated with membership in the Well Below class included: lower annual income, a higher level of comorbidity, being diagnosed with depression and back pain, and lack of regular exercise. Compared to the Above class, patients in the other two classes had significantly poorer QOL outcomes. Conclusions Almost 65% of older oncology patients reported significant decrements in physical function that persisted over two cycles of CTX. Clinicians can assess for those characteristics associated with poorer functional status to identify high risk patients and initiate appropriate interventions.

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“…Prior work has shown that the quality of chemotherapy for ovarian cancer is highly variable; chemotherapy is frequently omitted when indicated or delivered in a suboptimal manner. 27,28 Going forward, strategies to optimize adjuvant chemotherapy for women with ovarian cancer are clearly needed.…”

Section: Discussionmentioning

confidence: 99%

Utilization and Toxicity of Alternative Delivery Methods of Adjuvant Chemotherapy for Ovarian Cancer

Wright

Hou

Burke

et al. 2016

Obstetrics &Amp; Gynecology

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Objective Compared to conventional intravenous platinum and taxane-based chemotherapy for ovarian cancer, both intraperitoneal chemotherapy and more frequent dose-dense intravenous chemotherapy have been associated with improved survival in some studies. We examined the utilization and toxicity of these three methods of chemotherapy delivery in women with ovarian cancer. Methods We performed a population-based study and analyzed data on women with ovarian cancer who underwent primary surgery followed by platinum and taxane-based chemotherapy from 2009–2013 who were recorded in the MarketScan database. Adjuvant chemotherapy was classified as: intraperitoneal chemotherapy, dose-dense chemotherapy (weekly administration of chemotherapy), or standard chemotherapy (every 3 weeks). Hospitalizations and emergency department visits for chemotherapy-associated complications and costs were recorded and compared using χ2 tests. Results A total of 5,892 patients, including 4,135 (70.2%) who received standard chemotherapy, 859 (14.6%) who received intraperitoneal chemotherapy, and 898 (15.2%) treated with dose-dense chemotherapy were identified. From 2009 to 2013, use of intraperitoneal chemotherapy remained constant (16.3% to 16.3%) while use of dose-dense therapy increased (8.7% to 18.1%) (P<0.001). Hospitalizations for chemotherapy-associated complications occurred in 21.3% of women receiving standard chemotherapy, 34.7% of patients treated with intraperitoneal therapy, and in 25.2% of those receiving dose-dense treatment (P<0.001), while emergency department visits occurred in 18.3%, 26.3%, and 20.3%, respectively (P<0.001). The largest differences in hospitalizations and emergency visits were seen for gastrointestinal toxicities and electrolyte disorders. The per-patient costs of hospitalization were higher for intraperitoneal chemotherapy than other treatment modalities. Conclusion Intraperitoneal chemotherapy was used in less than 15% of women with ovarian cancer, while use of dose-dense chemotherapy is increasing. While we did not examine survival, intraperitoneal chemotherapy is significantly more toxic than the other methods of treatment.

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Completion of Adjuvant Chemotherapy and Use of Health Services for Older Women With Epithelial Ovarian Cancer

Cited by 57 publications

References 23 publications

Assessment of Solid Cancer Treatment Feasibility in Older Patients: A Prospective Cohort Study

Assessment of Solid Cancer Treatment Feasibility in Older Patients: A Prospective Cohort Study

Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy

Utilization and Toxicity of Alternative Delivery Methods of Adjuvant Chemotherapy for Ovarian Cancer

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