title: Intraperitoneal chemotherapy among women in the Medicare population with epithelial ovarian cancer.
abstract: BACKGROUND
  Intraperitoneal combined with intravenous chemotherapy (IV/IP) for primary treatment of epithelial ovarian cancer results in a substantial survival advantage for women who are optimally debulked surgically, compared with standard IV only therapy (IV). Little is known about the use of this therapy in the Medicare population.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 4665 women aged 66 and older with epithelial ovarian cancer diagnosed between 2005-2009, with their Medicare claims. We defined receipt of any IV/IP chemotherapy when there was claims evidence of any receipt of such treatment within 12 months of the date of diagnosis. We used descriptive statistics to examine factors associated with treatment and health services use.
  
  
  RESULTS
  Among 3561 women with Stage III or IV epithelial ovarian cancer who received any chemotherapy, only 124 (3.5%) received IV/IP chemotherapy. The use of IV/IP chemotherapy did not increase over the period of the study. In this cohort, younger women, those with fewer comorbidities, whites, and those living in Census tracts with higher income were more likely to receive IV/IP chemotherapy. Among women who received any IV/IP chemotherapy, we did not find an increase in acute care services (hospitalizations, emergency department visits, or ICU stays).
  
  
  CONCLUSIONS
  During the period between 2005 and 2009, few women in the Medicare population living within observed SEER areas received IV/IP chemotherapy, and the use of this therapy did not increase. We observed marked racial and sociodemographic differences in access to this therapy.
authors: Center of Outcomes Research and Evaluation, Maine Medical Center Research Institute, Maine Medical Center, Portland, ME, USA; Department of Medicine, Maine Medical Center, Portland, ME, USA. Electronic address: fairfk@mmc.org.
authors: Kathleen M
authors: KM
authors: Fairfield
authors: Center of Outcomes Research and Evaluation, Maine Medical Center Research Institute, Maine Medical Center, Portland, ME, USA.
authors: Kimberly
authors: K
authors: Murray
authors: Department of Gynecologic Oncology, Maine Medical Center, Portland, ME, USA.
authors: Jason A
authors: JA
authors: LaChance
authors: Department of Geriatrics, Maine Medical Center, Portland, ME, USA.
authors: Heidi R
authors: HR
authors: Wierman
authors: Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors: Craig C
authors: CC
authors: Earle
authors: Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA.
authors: Edward L
authors: EL
authors: Trimble
authors: Applied Research Program, National Cancer Institute, Bethesda, MD, USA.
authors: Joan L
authors: JL
authors: Warren
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D007263:Infusions, Parenteral; D006278:Medicare; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D014481:United States
chemical_list: D000970:Antineoplastic Agents
keywords: Disparities; Intraperitoneal chemotherapy; Ovarian cancer