title: Trends in treatment of advanced epithelial ovarian cancer in the Medicare population.
abstract: OBJECTIVE
  Optimal care for most patients with advanced ovarian cancer generally includes both surgery and chemotherapy. Little is known about the proportion of women in the US who receive combination care or the sequence in which this care is delivered. This study evaluated patterns of care, frequency of completion of recommended therapy and factors associated with sequencing of therapy.
  
  
  METHODS
  Using the Surveillance, Epidemiology and End-Results data we identified a cohort of 8211 women aged 65 and above with stage III/IV epithelial ovarian cancer diagnosed between 1995 and 2005. Receipt of chemotherapy or surgery was identified using Medicare claims. Logistic regression was used to evaluate factors associated with sequencing of treatment and the receipt of surgery.
  
  
  RESULTS
  3241 (39.1%) had surgery and at least 6 cycles of chemotherapy in either order. Surgery was performed initially in 4827 (58.8%) women and 3658/4827 (75.8%) had subsequent chemotherapy. 2017 (24.6%) had primary chemotherapy and 649/2017 (32.2%) of these women had subsequent surgery. Advanced age, African American race, stage IV disease, non-married status and increasing medical comorbidity were all associated with the failure to receive both surgery and at least 6 cycles of chemotherapy (all p<0.01).
  
  
  CONCLUSIONS
  The majority of women with advanced ovarian cancer in the Medicare population do not receive both combination therapy with surgery and at least 6 cycles of chemotherapy. A large proportion of women are receiving chemotherapy as primary treatment for advanced ovarian cancer, and the majority of these patients do not have cancer-directed surgery.
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA. mthrall@uw.edu
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Thrall
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Gray
authors.forename: Rebecca Gaston
authors.initials: RG
authors.lastname: Symons
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Goff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D003131:Combined Modality Therapy / Q000639:trends; D004358:Drug Therapy / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D006278:Medicare / Q000706:statistics & numerical data*; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy / Q000191:economics / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000191:economics / Q000601:surgery; D018426:SEER Program; D014481:United States