Indicators of survival duration in ovarian cancer and implications for aggressiveness of care.
BACKGROUND
Ovarian cancer patients frequently receive chemotherapy near the end of life. The purpose of the current study was to develop indicators that characterize those ovarian cancer patients who have a short life span.


METHODS
The medical charts of deceased epithelial ovarian cancer patients were retrospectively reviewed from 2000 through 2006. All patients received primary debulking surgery and adjuvant chemotherapy. Aggressiveness of cancer care within the last month of life was measured by chemotherapy regimens, emergency room visits, and hospitalizations. Significant clinical events (SCE) were defined as ascites, bowel obstruction, and pleural effusion. Survival quartiles were compared using chi-square and Student t test statistics. Multiple regression analysis was performed using survival duration as a dependent variable.


RESULTS
In all, 113 patients with epithelial ovarian cancer were reviewed. Patients had increased hospitalizations (P < .001) and SCE (P < .001) as they approached the end of life. There was no difference in the pattern of hospitalizations and SCE between the top and bottom survival quartiles. Patients with a shorter survival time had a trend toward increased chemotherapy during their last 3 months of life (P = .057) and had increased overall aggressiveness of care (P = .013). In patients with a disease remission, the length of initial remission time was found to be significant in predicting survival (P < .01). Time to second disease recurrence was also significant in predicting survival time (P < 0.01).


CONCLUSIONS
Patients who received aggressive care did not have improvement in survival. Short disease remissions and increasing hospitalizations with SCE should be indicators of the appropriateness of reducing cure-oriented therapies and increasing palliative interventions.
von Gruenigen
Vivian
V
Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA. vivian.vongruenigen@UHhospitals.org
Daly
Barbara
B
Gibbons
Heidi
H
Hutchins
Jessica
J
Green
Andrew
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002173:Cancer Care Facilities; D017024:Chemotherapy, Adjuvant; D004638:Emergency Treatment; D005260:Female; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D010166:Palliative Care; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000473:pathology; D011183:Postoperative Complications; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate