Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States
Abstract Objective Neoadjuvant chemotherapy and interval debulking surgery for the treatment of advanced ovarian cancer has remained controversial, despite the publication of two randomized trials comparing this modality with primary cytoreductive surgery. This study describes temporal trends in the...
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| Veröffentlicht in: | Gynecologic oncology 2016-11, Vol.143 (2), p.236-240 |
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| creator | Melamed, Alexander, MD, MPH Hinchcliff, Emily M., MD Clemmer, Joel T., MA Bregar, Amy J., MD, MS Uppal, Shitanshu, MD Bostock, Ian, MD Schorge, John O., MD del Carmen, Marcela G., MD, MPH Rauh-Hain, J. Alejandro, MD |
| description | Abstract Objective Neoadjuvant chemotherapy and interval debulking surgery for the treatment of advanced ovarian cancer has remained controversial, despite the publication of two randomized trials comparing this modality with primary cytoreductive surgery. This study describes temporal trends in the utilization of neoadjuvant chemotherapy and interval debulking surgery in clinical practice in the United States. Methods We completed a time trend analysis of the National Cancer Data Base. We identified women with stage IIIC and IV epithelial ovarian cancer diagnosed between 2004 and 2013. We categorized subjects as having undergone one of four treatment modalities: primary cytoreductive surgery followed by adjuvant chemotherapy, neoadjuvant chemotherapy followed by interval debulking surgery, surgery only, and chemotherapy only. Temporal trends in the frequency of treatment modalities were evaluated using Joinpoint regression, and χ2 tests. Results We identified 40,694 women meeting inclusion criteria, of whom 27,032 (66.4%) underwent primary cytoreductive surgery and adjuvant chemotherapy, 5429 (13.3%) received neoadjuvant chemotherapy and interval surgery, 5844 (15.4%) had surgery only, and 2389 (5.9%) received chemotherapy only. The proportion of women receiving neoadjuvant chemotherapy and surgery increased from 8.6% to 22.6% between 2004 and 2013 ( p < 0.001), and adoption of this treatment modality occurred primarily after 2007 (95%CI 2006–2009; p = 0.001). During this period, the proportion of women who received primary cytoreductive surgery and chemotherapy declined from 68.1% to 60.8% ( p < 0.001), and the proportion who underwent surgery only declined from 17.8% to 9.9% ( p < 0.001). Conclusion Between 2004 and 2013 the frequency of neoadjuvant chemotherapy and interval surgery increased significantly in the United States. |
| doi_str_mv | 10.1016/j.ygyno.2016.09.002 |
| format | Article |
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Alejandro, MD</creator><creatorcontrib>Melamed, Alexander, MD, MPH ; Hinchcliff, Emily M., MD ; Clemmer, Joel T., MA ; Bregar, Amy J., MD, MS ; Uppal, Shitanshu, MD ; Bostock, Ian, MD ; Schorge, John O., MD ; del Carmen, Marcela G., MD, MPH ; Rauh-Hain, J. Alejandro, MD</creatorcontrib><description>Abstract Objective Neoadjuvant chemotherapy and interval debulking surgery for the treatment of advanced ovarian cancer has remained controversial, despite the publication of two randomized trials comparing this modality with primary cytoreductive surgery. This study describes temporal trends in the utilization of neoadjuvant chemotherapy and interval debulking surgery in clinical practice in the United States. Methods We completed a time trend analysis of the National Cancer Data Base. We identified women with stage IIIC and IV epithelial ovarian cancer diagnosed between 2004 and 2013. We categorized subjects as having undergone one of four treatment modalities: primary cytoreductive surgery followed by adjuvant chemotherapy, neoadjuvant chemotherapy followed by interval debulking surgery, surgery only, and chemotherapy only. Temporal trends in the frequency of treatment modalities were evaluated using Joinpoint regression, and χ2 tests. Results We identified 40,694 women meeting inclusion criteria, of whom 27,032 (66.4%) underwent primary cytoreductive surgery and adjuvant chemotherapy, 5429 (13.3%) received neoadjuvant chemotherapy and interval surgery, 5844 (15.4%) had surgery only, and 2389 (5.9%) received chemotherapy only. The proportion of women receiving neoadjuvant chemotherapy and surgery increased from 8.6% to 22.6% between 2004 and 2013 ( p < 0.001), and adoption of this treatment modality occurred primarily after 2007 (95%CI 2006–2009; p = 0.001). During this period, the proportion of women who received primary cytoreductive surgery and chemotherapy declined from 68.1% to 60.8% ( p < 0.001), and the proportion who underwent surgery only declined from 17.8% to 9.9% ( p < 0.001). Conclusion Between 2004 and 2013 the frequency of neoadjuvant chemotherapy and interval surgery increased significantly in the United States.</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2016.09.002</identifier><identifier>PMID: 27612977</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Advanced ovarian cancer ; Aged ; Aged, 80 and over ; Chemotherapy, Adjuvant ; Female ; Hematology, Oncology and Palliative Medicine ; Humans ; Middle Aged ; Neoadjuvant chemotherapy ; Neoadjuvant Therapy ; Neoplasm Staging ; Obstetrics and Gynecology ; Ovarian Neoplasms - diagnosis ; Ovarian Neoplasms - drug therapy ; Ovarian Neoplasms - therapy ; Temporal trends</subject><ispartof>Gynecologic oncology, 2016-11, Vol.143 (2), p.236-240</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c480t-142ae107e53036a16d4298e94668d9041d6fa11bef2fc1c89f3d13381602c3163</citedby><cites>FETCH-LOGICAL-c480t-142ae107e53036a16d4298e94668d9041d6fa11bef2fc1c89f3d13381602c3163</cites><orcidid>0000-0002-0654-0863</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ygyno.2016.09.002$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27612977$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Melamed, Alexander, MD, MPH</creatorcontrib><creatorcontrib>Hinchcliff, Emily M., MD</creatorcontrib><creatorcontrib>Clemmer, Joel T., MA</creatorcontrib><creatorcontrib>Bregar, Amy J., MD, MS</creatorcontrib><creatorcontrib>Uppal, Shitanshu, MD</creatorcontrib><creatorcontrib>Bostock, Ian, MD</creatorcontrib><creatorcontrib>Schorge, John O., MD</creatorcontrib><creatorcontrib>del Carmen, Marcela G., MD, MPH</creatorcontrib><creatorcontrib>Rauh-Hain, J. Alejandro, MD</creatorcontrib><title>Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>Abstract Objective Neoadjuvant chemotherapy and interval debulking surgery for the treatment of advanced ovarian cancer has remained controversial, despite the publication of two randomized trials comparing this modality with primary cytoreductive surgery. This study describes temporal trends in the utilization of neoadjuvant chemotherapy and interval debulking surgery in clinical practice in the United States. Methods We completed a time trend analysis of the National Cancer Data Base. We identified women with stage IIIC and IV epithelial ovarian cancer diagnosed between 2004 and 2013. We categorized subjects as having undergone one of four treatment modalities: primary cytoreductive surgery followed by adjuvant chemotherapy, neoadjuvant chemotherapy followed by interval debulking surgery, surgery only, and chemotherapy only. Temporal trends in the frequency of treatment modalities were evaluated using Joinpoint regression, and χ2 tests. Results We identified 40,694 women meeting inclusion criteria, of whom 27,032 (66.4%) underwent primary cytoreductive surgery and adjuvant chemotherapy, 5429 (13.3%) received neoadjuvant chemotherapy and interval surgery, 5844 (15.4%) had surgery only, and 2389 (5.9%) received chemotherapy only. The proportion of women receiving neoadjuvant chemotherapy and surgery increased from 8.6% to 22.6% between 2004 and 2013 ( p < 0.001), and adoption of this treatment modality occurred primarily after 2007 (95%CI 2006–2009; p = 0.001). During this period, the proportion of women who received primary cytoreductive surgery and chemotherapy declined from 68.1% to 60.8% ( p < 0.001), and the proportion who underwent surgery only declined from 17.8% to 9.9% ( p < 0.001). Conclusion Between 2004 and 2013 the frequency of neoadjuvant chemotherapy and interval surgery increased significantly in the United States.</description><subject>Adult</subject><subject>Advanced ovarian cancer</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Chemotherapy, Adjuvant</subject><subject>Female</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Neoadjuvant chemotherapy</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Obstetrics and Gynecology</subject><subject>Ovarian Neoplasms - diagnosis</subject><subject>Ovarian Neoplasms - drug therapy</subject><subject>Ovarian Neoplasms - therapy</subject><subject>Temporal trends</subject><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9v1DAQxS0EokvhEyAhH7kkjO3EsQ8goar8kSpxaHvFcu0JdcjGi52slG-Pw7YcuHCyxvPejN5vCHnNoGbA5LuhXn-sU6x5KWrQNQB_QnYMdFtJ1eqnZAegoVK8VWfkRc4DAAhg_Dk5451kXHfdjny_STj5TMNE53ukS0YaezphtH5YjnaaqbvHfSy9ZA8r7WOi1pd_h57Go03BTtRtZXoccTuFuTSvZztjfkme9XbM-OrhPSe3ny5vLr5UV98-f734eFW5RsFcsYZbZNBhK0BIy6RvuFaoGymV19AwL3vL2B32vHfMKd0Lz4RQTAJ3gklxTt6e5h5S_LVgns0-ZIfjaEuUJRumRNsWneyKVJykLsWcE_bmkMLeptUwMBtYM5g_YM0G1oA2BWxxvXlYsNzt0f_1PJIsgvcnAZaYx4DJZBdw4xQSutn4GP6z4MM_fjeGKTg7_sQV8xCXNBWChpnMDZjr7bbbaUsoJmSrxG8p3p8S</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Melamed, Alexander, MD, MPH</creator><creator>Hinchcliff, Emily M., MD</creator><creator>Clemmer, Joel T., MA</creator><creator>Bregar, Amy J., MD, MS</creator><creator>Uppal, Shitanshu, MD</creator><creator>Bostock, Ian, MD</creator><creator>Schorge, John O., MD</creator><creator>del Carmen, Marcela G., MD, MPH</creator><creator>Rauh-Hain, J. Alejandro, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0654-0863</orcidid></search><sort><creationdate>20161101</creationdate><title>Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States</title><author>Melamed, Alexander, MD, MPH ; Hinchcliff, Emily M., MD ; Clemmer, Joel T., MA ; Bregar, Amy J., MD, MS ; Uppal, Shitanshu, MD ; Bostock, Ian, MD ; Schorge, John O., MD ; del Carmen, Marcela G., MD, MPH ; Rauh-Hain, J. Alejandro, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c480t-142ae107e53036a16d4298e94668d9041d6fa11bef2fc1c89f3d13381602c3163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Advanced ovarian cancer</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Chemotherapy, Adjuvant</topic><topic>Female</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Neoadjuvant chemotherapy</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Obstetrics and Gynecology</topic><topic>Ovarian Neoplasms - diagnosis</topic><topic>Ovarian Neoplasms - drug therapy</topic><topic>Ovarian Neoplasms - therapy</topic><topic>Temporal trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Melamed, Alexander, MD, MPH</creatorcontrib><creatorcontrib>Hinchcliff, Emily M., MD</creatorcontrib><creatorcontrib>Clemmer, Joel T., MA</creatorcontrib><creatorcontrib>Bregar, Amy J., MD, MS</creatorcontrib><creatorcontrib>Uppal, Shitanshu, MD</creatorcontrib><creatorcontrib>Bostock, Ian, MD</creatorcontrib><creatorcontrib>Schorge, John O., MD</creatorcontrib><creatorcontrib>del Carmen, Marcela G., MD, MPH</creatorcontrib><creatorcontrib>Rauh-Hain, J. Alejandro, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Melamed, Alexander, MD, MPH</au><au>Hinchcliff, Emily M., MD</au><au>Clemmer, Joel T., MA</au><au>Bregar, Amy J., MD, MS</au><au>Uppal, Shitanshu, MD</au><au>Bostock, Ian, MD</au><au>Schorge, John O., MD</au><au>del Carmen, Marcela G., MD, MPH</au><au>Rauh-Hain, J. Alejandro, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>143</volume><issue>2</issue><spage>236</spage><epage>240</epage><pages>236-240</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><abstract>Abstract Objective Neoadjuvant chemotherapy and interval debulking surgery for the treatment of advanced ovarian cancer has remained controversial, despite the publication of two randomized trials comparing this modality with primary cytoreductive surgery. This study describes temporal trends in the utilization of neoadjuvant chemotherapy and interval debulking surgery in clinical practice in the United States. Methods We completed a time trend analysis of the National Cancer Data Base. We identified women with stage IIIC and IV epithelial ovarian cancer diagnosed between 2004 and 2013. We categorized subjects as having undergone one of four treatment modalities: primary cytoreductive surgery followed by adjuvant chemotherapy, neoadjuvant chemotherapy followed by interval debulking surgery, surgery only, and chemotherapy only. Temporal trends in the frequency of treatment modalities were evaluated using Joinpoint regression, and χ2 tests. Results We identified 40,694 women meeting inclusion criteria, of whom 27,032 (66.4%) underwent primary cytoreductive surgery and adjuvant chemotherapy, 5429 (13.3%) received neoadjuvant chemotherapy and interval surgery, 5844 (15.4%) had surgery only, and 2389 (5.9%) received chemotherapy only. The proportion of women receiving neoadjuvant chemotherapy and surgery increased from 8.6% to 22.6% between 2004 and 2013 ( p < 0.001), and adoption of this treatment modality occurred primarily after 2007 (95%CI 2006–2009; p = 0.001). During this period, the proportion of women who received primary cytoreductive surgery and chemotherapy declined from 68.1% to 60.8% ( p < 0.001), and the proportion who underwent surgery only declined from 17.8% to 9.9% ( p < 0.001). Conclusion Between 2004 and 2013 the frequency of neoadjuvant chemotherapy and interval surgery increased significantly in the United States.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27612977</pmid><doi>10.1016/j.ygyno.2016.09.002</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-0654-0863</orcidid></addata></record> |
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| subjects | Adult Advanced ovarian cancer Aged Aged, 80 and over Chemotherapy, Adjuvant Female Hematology, Oncology and Palliative Medicine Humans Middle Aged Neoadjuvant chemotherapy Neoadjuvant Therapy Neoplasm Staging Obstetrics and Gynecology Ovarian Neoplasms - diagnosis Ovarian Neoplasms - drug therapy Ovarian Neoplasms - therapy Temporal trends |
| title | Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States |
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