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

Wright, Jason D.; Hou, June Y.; Burke, William M.; Tergas, Ana I.; Chen, Ling; Hu, Jim C.; Ananth, Cande V.; Neugut, Alfred I.; Hershman, Dawn L.

doi:10.1097/aog.0000000000001436

Cited by 24 publications

(21 citation statements)

References 28 publications

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“…Of course, maximal efforts should be made to eradicate the tumor as much as possible. Although recent evidences highlighted the value of precise medicine, personalized and individual therapy, along with targeted therapy for cancer patients [147][148][149][150][151]-the net health benefits (NHBs), cost-effectiveness or quality of life may reflect the relative value of treatment options in EOC [100,[152][153][154][155][156][157]. With the low risk of AEs, shortened therapeutic period, and, of most importance, working without compromising therapeutic effects-low-dose triweekly cisplatin plus dose-dense weekly paclitaxel might be associated with better NHBs, a better cost-effectiveness, and a better QOL compared to a carboplatin-based dose-dense paclitaxel regimen.…”

Section: Discussionmentioning

confidence: 99%

Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

Huang

Chen

Lee

et al. 2020

IJERPH

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The use of weekly chemotherapy for the treatment of patients with advanced-stage serous-type epithelial Tubo-ovarian cancer (ETOC), and primary peritoneal serous carcinoma (PPSC) is acceptable as the front-line postoperative chemotherapy after primary cytoreductive surgery (PCS). The main component of dose-dense chemotherapy is weekly paclitaxel (80 mg/m2), but it would be interesting to know what is the difference between combination of triweekly cisplatin (20 mg/m2) or triweekly carboplatin (carboplatin area under the curve 5-7 mg/mL per min [AUC 5-7]) in the dose-dense paclitaxel regimen. Therefore, we compared the outcomes of women with Gynecology and Obstetrics (FIGO) stage IIIC ETOC and PPSC treated with PCS and a subsequent combination of dose-dense weekly paclitaxel and triweekly cisplatin (paclitaxel–cisplatin) or triweekly carboplatin using AUC 5 (paclitaxel–carboplatin). Between January 2010 and December 2016, 40 women with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC EOC, FTC, or PPSC were enrolled, including 18 treated with paclitaxel–cisplatin and the remaining 22 treated with paclitaxel–carboplatin. There were no statistically significant differences in disease characteristics of patients between two groups. Outcomes in paclitaxel–cisplatin group seemed to be little better than those in paclitaxel–carboplatin (median progression-free survival [PFS] 30 versus 25 months as well as median overall survival [OS] 58.5 versus 55.0 months); however, neither reached a statistically significant difference. In terms of adverse events (AEs), patients in paclitaxel–carboplatin group had more AEs, with a higher risk of neutropenia and grade 3/4 neutropenia, and the need for a longer period to complete the front-line chemotherapy, and the latter was associated with worse outcome for patients. We found that a period between the first-time chemotherapy to the last dose (6 cycles) of chemotherapy >21 weeks was associated with a worse prognosis in patients compared to that ≤21 weeks, with hazard ratio (HR) of 81.24 for PFS and 9.57 for OS. As predicted, suboptimal debulking surgery (>1 cm) also contributed to a worse outcome than optimal debulking surgery (≤1 cm) with HR of 14.38 for PFS and 11.83 for OS. Based on the aforementioned findings, both regimens were feasible and effective, but maximal efforts should be made to achieve optimal debulking surgery and following the on-schedule administration of dose-dense weekly paclitaxel plus triweekly platinum compounds. Randomized trials validating the findings are warranted.

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Section: Discussionmentioning

confidence: 99%

Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

Huang

Chen

Lee

et al. 2020

IJERPH

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“…Intraperitoneal (IP) chemotherapy combined with systemic platinum‐based chemotherapy may confer an OS benefit for patients medically fit enough to receive adjuvant therapy . This effect is associated with the number of cycles, and toxicities are frequently related to fatigue, neuropathy, renal function, and abdominal discomfort, and are catheter‐related …”

Section: Methodsmentioning

confidence: 99%

Surgery in ovarian cancer – Brazilian Society of Surgical Oncology consensus

Tsunoda

Ribeiro

Reis

et al. 2018

BJOG

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“…This database allows for the longitudinal study of patient data and enrollment. 10,11 . The study used de-identified data and was deemed exempt by the Columbia University Institutional Review Board.…”

Section: Methodsmentioning

confidence: 99%

Cost of Care for the Initial Management of Ovarian Cancer

Bercow

Chen

Chatterjee

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To examine the cost of care during the first year after a diagnosis of ovarian cancer, estimate the sources of cost, and explore the out-of-pocket costs. Methods We performed a retrospective, cohort study of women with ovarian cancer diagnosed from 2009–2012 who underwent both surgery using the Truven Health MarketScan database. This database is comprised of patients covered by commercial insurance sponsored by over 100 employers in the United States. Medical expenditures, including physician reimbursement, for a 12-month period beginning on the date of surgery were estimated. All payments were examined, including out-of-pocket costs for patients. Payments were divided into expenditures for inpatient care, outpatient care (including chemotherapy), and outpatient drug costs. The 12-month treatment period was divided into 3 phases: surgery-30 days (operative period), 1–6 months (adjuvant therapy), and 6–12 months after surgery. The primary outcome was the overall cost of care within the first year of diagnosis of ovarian cancer, while secondary outcomes included assessment of factors associated with cost. Results A total of 26,548 women with ovarian cancer who underwent surgery were identified. After exclusion of patients with incomplete insurance enrollment/coverage, those who did not undergo chemotherapy, and those with capitated plans, our cohort consisted of 5,031 women. The median total medical expenditures per patient during the first year after the index procedure was $93,632 (interquartile range [IQR] $62,319–140,140). Inpatient services accounted for $30,708 (IQR, $20,102–51,107; 37.8%) in expenditures, outpatient services $52,700 (IQR, $31,210–83,206; 58.3%) and outpatient drug costs $1,814 (IQR, $603–4,402; 3.8%). The median out-of-pocket expense was $2988 (IQR, $1649–5088). This included $1509 (IQR, $705–2878) for outpatient services, $589 (IQR, $3–1715) for inpatient services, and $351 (IQR, $149–656) for outpatient drug costs. Conclusion The average cost of care for women with ovarian cancer in the first year after surgery is approximately $100,000. Patients bear approximately 3% of these costs in the form of out-of-pocket expenses.

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

Cited by 24 publications

References 28 publications

Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

Surgery in ovarian cancer – Brazilian Society of Surgical Oncology consensus

Cost of Care for the Initial Management of Ovarian Cancer

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