title: Delay in chemotherapy administration impacts survival in elderly patients with epithelial ovarian cancer.
abstract: OBJECTIVE
  The objective of this study was to characterize chemotherapy treatment patterns in elderly patients with epithelial ovarian cancer (EOC) and their impact on overall survival (OS).
  
  
  METHODS
  We identified patients age ≥65years with stage II-IV EOC who underwent cytoreduction from 2003 to 2011. Relevant clinical variables were extracted and correlated with OS. Statistical analyses were performed using logistic regression, Kaplan-Meier methods, and multivariable Cox proportional hazard models.
  
  
  RESULTS
  One hundred and eighty-four patients were included in the analysis. The average age was 73years with American Society of Anesthesiology Physical Status Class 2 or 3. Approximately 78% underwent primary debulking surgery (PDS). OS for the entire cohort was 3.3years. One hundred and fifty-seven patients received adjuvant chemotherapy, of which 70% received initial platinum-based doublet therapy; 67.5% of patients were able to complete the intended six cycles of chemotherapy; of these, 34% experienced a dose reduction and 45% experienced one or more dose delays. Any dose delay was associated with a decrease in overall survival (p=0.02) and remained significant even after controlling for age, stage, and residual disease and number of chemotherapy cycles received (p=0.029).
  
  
  CONCLUSIONS
  Elderly EOC patients frequently required chemotherapy dose reductions and delays in chemotherapy administration. Multivariate analysis confirmed that dose delays are an independent factor associated with decreased OS.
authors.affiliation: Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Founders 5 Suite 546A, Boston, MA 02115, USA. Electronic address: njoseph11@partners.org.
authors.forename: Naima
authors.initials: N
authors.lastname: Joseph
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Founders 5 Suite 546A, Boston, MA 02115, USA. Electronic address: rmclark@mgh.harvard.edu.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Clark
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Founders 5 Suite 546A, Boston, MA 02115, USA. Electronic address: ddizon@mgh.harvard.edu.
authors.forename: Don S
authors.initials: DS
authors.lastname: Dizon
authors.affiliation: Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Founders 5 Suite 546A, Boston, MA 02115, USA. Electronic address: mlee33@partners.org.
authors.forename: Malinda S
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Founders 5 Suite 546A, Boston, MA 02115, USA. Electronic address: agoodman@mgh.harvard.edu.
authors.forename: Annekathryn
authors.initials: A
authors.lastname: Goodman
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Founders 5 Suite 546A, Boston, MA 02115, USA. Electronic address: dboruta@mgh.harvard.edu.
authors.forename: David
authors.initials: D
authors.lastname: Boruta
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Founders 5 Suite 546A, Boston, MA 02115, USA. Electronic address: jschorge@partners.org.
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Founders 5 Suite 546A, Boston, MA 02115, USA. Electronic address: mdelcarmen@mgh.harvard.edu.
authors.forename: Marcela G
authors.initials: MG
authors.lastname: Del Carmen
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Founders 5 Suite 546A, Boston, MA 02115, USA. Electronic address: wgrowdon@partners.org.
authors.forename: Whitfield B
authors.initials: WB
authors.lastname: Growdon
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000503:physiopathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D009375:Neoplasms, Glandular and Epithelial / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D009503:Neutropenia / Q000503:physiopathology; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010051:Ovarian Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D061665:Time-to-Treatment
chemical_list: D009944:Organoplatinum Compounds
keywords: Chemotherapy; Dose delay; Elderly; Ovarian cancer