title: Completion of adjuvant chemotherapy and use of health services for older women with epithelial ovarian cancer.
abstract: OBJECTIVE
  This analysis identifies factors associated with completion of adjuvant chemotherapy for patients with ovarian cancer and subsequent use of health services.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare database to identify 4,617 women age 65 years or older with ovarian cancer diagnosed from 2001 to 2005. By using multivariable analyses with completion of chemotherapy as the outcome of interest, we describe factors associated with completion of treatment, including age, race, marital status, comorbidities, and sociodemographic factors. Use of health services was captured from Medicare claims.
  
  
  RESULTS
  Among 4,617 patients with untreated ovarian cancer, 1,329 (28.8%) received no chemotherapy, 1,139 (24.7%) received a partial course of chemotherapy, and 2,149 (46.5%) completed chemotherapy. Women age 75 years or older were at greater risk of incomplete chemotherapy versus women age 65 to 74 years (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.04). Having two or more comorbidities was also significantly associated with incomplete chemotherapy (OR, 1.83; 95% CI, 1.34 to 2.50). Among women who received either a partial or complete course of chemotherapy, we did not find an increase in use of health services (hospitalizations, emergency department visits, or physician visits) for the oldest women (age 80 years or older) compared with younger women.
  
  
  CONCLUSIONS
  There is considerable room for improvement in helping older patients with ovarian cancer initiate and complete chemotherapy. The oldest women who completed chemotherapy in this study did not use health services more than younger women did. Treatment teams for older patients with ovarian cancer should include expertise in geriatric assessment, should carefully identify medical and psychosocial barriers to completing treatment, and should support patients throughout treatment.
authors.affiliation: Maine Medical Center Research Institute, Maine Medical Center, Portland, ME 04102, USA. fairfk@mmc.org
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Fairfield
authors.forename: Kimberly
authors.initials: K
authors.lastname: Murray
authors.forename: F Lee
authors.initials: FL
authors.lastname: Lucas
authors.forename: Heidi R
authors.initials: HR
authors.lastname: Wierman
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: Edward L
authors.initials: EL
authors.lastname: Trimble
authors.forename: Laurie
authors.initials: L
authors.lastname: Small
authors.forename: Joan L
authors.initials: JL
authors.lastname: Warren
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D018426:SEER Program; D014481:United States