Preoperative predictors of delay in initiation of adjuvant chemotherapy in patients undergoing primary debulking surgery for ovarian cancer.
OBJECTIVE
The objective of this study was to identify preoperative characteristics of patients that experience a delay in initiation of adjuvant chemotherapy after primary debulking surgery for ovarian cancer.


METHODS
We performed a retrospective review of patients with Stage II to IV high-grade epithelial ovarian, tubal, and peritoneal carcinoma who underwent primary debulking surgery followed by adjuvant chemotherapy from 2005 to 2013. Patients were divided into 2 groups: Control (those who received their first cycle of chemotherapy within 6weeks of debulking surgery) vs. chemotherapy delay (those who received their first cycle of chemotherapy at an interval >6weeks from primary debulking surgery). Relevant clinical variables and survival outcomes were compared between the 2 groups using standard statistical methods.


RESULTS
A total of 221 patients were included in the analyses - 169 (76.5%) were in the control group and 52 (23.5%) were in the chemo delay group. On multi-variate analysis, risk factors that were significantly associated with a delay in initiation in chemotherapy included: age >65, albumin <3.5, and high age-adjusted Charlson Comorbidity Index score. Delay in chemotherapy initiation was associated with a shorter progression-free (p=0.014) but not overall survival (p=0.19).


CONCLUSIONS
Delay in initiation of chemotherapy affected 23.5% of patients in our study population. Easily identifiable risk factors for chemotherapy delay exist that can help us pre-operatively identify patients for which neoadjuvant chemotherapy may be a better treatment option. Further study into prospective modeling with these identified risk factors is warranted.
Division of Gynecologic Oncology, University Hospitals Case Medical Center, Cleveland, OH, United States. Electronic address: ssingh3@metrohealth.org.
Sareena
S
Singh
Department of OB/GYN, University Hospitals Case Medical Center, Cleveland, OH, United States.
Megan
M
Guetzko
Division of Gynecologic Oncology, MetroHealth Medical Center, Cleveland, OH, United States.
Kimberly
K
Resnick
D000368:Aged; D017024:Chemotherapy, Adjuvant; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors
Chemotherapy; Chemotherapy delay; Ovarian cancer