title: Impact of shifting from office- to hospital-based treatment facilities on the administration of intraperitoneal chemotherapy for ovarian cancer.
abstract: BACKGROUND
  Cancer chemotherapy in the United States has been delivered mostly in an office-based setting since the late 1980s. However, in the past 5 years, more patients have been treated in hospitals as a result of reimbursement changes. Intraperitoneal (IP) chemotherapy for ovarian cancer has been similarly affected. This report examines changes in care of women treated with IP chemotherapy in an office- versus hospital-based setting.
  
  
  METHODS
  Over 10 years, 140 women with ovarian cancer were identified as candidates for IP chemotherapy. Of these patients, 92 were treated in an oncology-dedicated infusion center in the office of a physicians' group; 48 were treated in a local hospital. Location was determined based on insurance coverage and reimbursement. Data collected included demographics, number of treatment cycles completed, length of each treatment, and adverse events.
  
  
  RESULTS
  The age and ethnicity of patients treated in the office versus hospital were similar. All six doses of intravenous IP chemotherapy were completed by 73 (79%) of 92 patients treated in the office versus 23 (48%) of 48 patients treated in the hospital (P < .001). The time of each infusion was longer in the hospital-versus office-based setting (P < .001). There were more adverse events associated with treatment in the hospital.
  
  
  CONCLUSIONS
  IP chemotherapy is associated with worse outcomes in the hospital- compared with office-based setting. The reason seems to involve a relative lack of resources directed specifically to chemotherapy administration. If current reimbursement trends continue, this could result in decreased survival for women with ovarian cancer.
authors.affiliation: Texas Tech University Health Sciences Center; and the Don and Sybil Harrington Cancer Center, Amarillo, TX.
authors.forename: William R
authors.initials: WR
authors.lastname: Robinson
authors.forename: Julie
authors.initials: J
authors.lastname: Beyer