Outcomes for systemic therapy in women with ovarian cancer

OBJECTIVES: To describe the association of systemic therapy delivery with overall survival for ovarian cancer. METHODS: This population-based cohort study included all newly diagnosed ovarian cancer patients treated from 1996 to 2002 in Ontario, Canada. Hospitalization and surgical billing databases were used. Multivariate analysis was used to evaluate the importance of hospital volume of first-line chemotherapy for ovarian cancer, hospital type, prescribing physician volume and that physician's specialty on overall survival. RESULTS: There were 2502 women who received systemic therapy as part of their management. The three management strategies were surgery followed by chemotherapy (64.9%), chemotherapy followed by interval surgery (14.4%) and chemotherapy alone (20.6%). There has been a shift over time to chemotherapy followed by interval surgery from 5.5% in 1996 to 26% in 2001. Rates for surgery followed by chemotherapy have remained constant. Of those treated with first line chemotherapy, approximately 66.25% of women receive combination chemotherapy and 20% of patients receive single agent platinum. When potential confounders were taken into account (age, comorbidity, and metastatic versus nonmetastatic disease) factors involved in the delivery of systemic therapy were not associated with survival. Survival was improved for those that are younger, with no comorbidities, no metastasis and surgery followed by chemotherapy. CONCLUSION: In Ontario, multimodality therapy with surgery followed by chemotherapy is associated with improved survival.