title: Utilization and Toxicity of Alternative Delivery Methods of Adjuvant Chemotherapy for Ovarian Cancer.
abstract: Compared with conventional intravenous platinum and taxane-based chemotherapy for ovarian cancer, both intraperitoneal chemotherapy and more frequent dose-dense intravenous chemotherapy have been associated with improved survival in some studies. We examined the utilization and toxicity of these three methods of chemotherapy delivery in women with ovarian cancer.
  
  
  
  We performed a population-based study and analyzed data on women with ovarian cancer who underwent primary surgery followed by platinum and taxane-based chemotherapy from 2009 to 2013 who were recorded in the MarketScan database. Adjuvant chemotherapy was classified as: intraperitoneal chemotherapy, dose-dense chemotherapy (weekly administration of chemotherapy), or standard chemotherapy (every 3 weeks). Hospitalizations and emergency department visits for chemotherapy-associated complications and costs were recorded and compared using χ tests.
  
  
  
  A total of 5,892 patients, including 4,135 (70.2%) who received standard chemotherapy, 859 (14.6%) who received intraperitoneal chemotherapy, and 898 (15.2%) treated with dose-dense chemotherapy, were identified. From 2009 to 2013, use of intraperitoneal chemotherapy remained constant (16.3-16.3%), whereas use of dose-dense therapy increased (8.7-18.1%) (P<.001). Hospitalizations for chemotherapy-associated complications occurred in 21.3% of women receiving standard chemotherapy, 34.7% of patients treated with intraperitoneal therapy, and in 25.2% of those receiving dose-dense treatment (P<.001); emergency department visits occurred in 18.3%, 26.3%, and 20.3%, respectively (P<.001). The largest differences in hospitalizations and emergency department visits were seen for gastrointestinal toxicities and electrolyte disorders. The per-patient costs of hospitalization were higher for intraperitoneal chemotherapy than other treatment modalities.
  
  
  
  Intraperitoneal chemotherapy was used in less than 15% of women with ovarian cancer, whereas use of dose-dense chemotherapy is increasing. Although we did not examine survival, intraperitoneal chemotherapy is significantly more toxic than the other methods of treatment.
authors.affiliation: Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York Presbyterian Hospital, and the Department of Urology, Weill Cornell Medical College, New York, New York.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: June Y
authors.initials: JY
authors.lastname: Hou
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000633:toxicity; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D016208:Databases, Factual; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000706:statistics & numerical data; D007263:Infusions, Parenteral / Q000706:statistics & numerical data; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology