Skip to main content

Advertisement

SpringerLink
Log in

An Audit on Factors Delaying Time to Chemotherapy in Stage IIB–IV Ovarian Cancer Patients After Primary Debulking Surgery

  • Original Article
  • Published:
Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Aims and Objectives

To identify risk factors associated with delay in adjuvant chemotherapy in ovarian cancer patients.

Materials and Methods

This is single institute retrospective study. All patients of highgrade epithelial ovarian, fallopian tube, and primary peritoneal carcinoma, FIGO Stage II–IV, who underwent PDS at our institution from January 2018 to December 2019 were included. Patients were excluded if they had non-epithelial ovarian histology, borderline tumors, or if they were declared unresectable or R-2 (> 2 cm residual tumor) resection at the end of surgery, synchronous tumors or if they received chemotherapy from outside our institution. The demographic data, biochemical parameters and surgical complexity score was recorded and analyzed statistically.

Results

We identified a total of 102 patients who met the inclusion criteria with a mean age of 60.1 years, SD 11.4. Of these, 22 patients (21.6%) experienced a delay in chemotherapy and 80 patients (78.4%) started chemotherapy without any delay. Our study highlighted that age > 65 years, low albumin preoperatively < 3.5 gm/dl, higher Clavin-Dindo scores (3–5) in the postoperative period was significantly associated with delay in chemotherapy after multivariate analysis.

Conclusion

This study enables the oncologist to understand factors that delay chemotherapy in advanced ovarian cancers post-surgery and would help in customizing the treatment for patients for better outcomes, target the delay group for high compliance and work towards improving the timeliness of chemotherapy initiation, enhancing patient outcomes to optimize the overall management of advanced ovarian cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Chandramohan K, Thomas B. Cancer trends and burden in India. Lancet Oncol. 2018;19(12):e663.

    Article  Google Scholar 

  2. Berek JS, Kehoe ST, Kumar L, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum. Int J Gynecol Obstet. 2018;143:59–78.

    Article  Google Scholar 

  3. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 2002;20(5):1248–59.

    Article  PubMed  Google Scholar 

  4. Sioulas VD, Schiavone MB, Kadouri D, Zivanovic O, Roche KL, O’Cearbhaill R, et al. Optimal primary management of bulky stage IIIC ovarian, fallopian tube and peritoneal carcinoma: are the only options complete gross resection at primary debulking surgery or neoadjuvant chemotherapy? Gynecol Oncol. 2017;145(1):15–20.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sinno AK, Li X, Thompson RE, Tanner EJ, Levinson KL, Stone RL, et al. Trends and factors associated with radical cytoreductive surgery in the United States: a case for centralized care. Gynecol Oncol. 2017;145(3):493–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Schorge JO, Bregar AJ, Durfee J, Berkowitz RS. Meigs to modern times: the evolution of debulking surgery in advanced ovarian cancer. Gynecol Oncol. 2018;149(3):447–54.

    Article  PubMed  Google Scholar 

  7. Fotopoulou C, Jones BP, Savvatis K, Campbell J, Kyrgiou M, Farthing A, et al. Maximal effort cytoreductive surgery for disseminated ovarian cancer in a UK setting: challenges and possibilities. Arch Gynecol Obstet. 2016;294(3):607–14.

    Article  PubMed  Google Scholar 

  8. Feng Z, Wen H, Bi R, Yang W, Wu X. Prognostic impact of the time interval from primary surgery to intravenous chemotherapy in high grade serous ovarian cancer. Gynecol Oncol. 2016;141(3):466–70.

    Article  PubMed  Google Scholar 

  9. Alvarez RD. We need a new paradigm in gynecologic cancer care: SGO proposes solutions for delivery, quality and reimbursement policies. Gynecol Oncol. 2013;129(1):3–4.

    Article  PubMed  Google Scholar 

  10. Bonte AS, Luyckx A, Wyckmans L, Trinh XB, Van Dam PA. Quality indicators for the management of endometrial, cervical and ovarian cancer. Eur J Surg Oncol. 2019;45(4):528–37.

    Article  PubMed  Google Scholar 

  11. Liu Y, Zhang T, Wu Q, Jiao Y, Gong T, Ma X, et al. Relationship between initiation time of adjuvant chemotherapy and survival in ovarian cancer patients: a dose-response meta-analysis of cohort studies. Sci Rep. 2017;7(1):9461.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Aletti GD, Dowdy SC, Podratz KC, Cliby WA. Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer. Am J Obstet Gynecol. 2007;197(6):676.e1-676.e7.

    Article  PubMed  Google Scholar 

  13. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51.

    Article  CAS  PubMed  Google Scholar 

  14. Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol. 1999;43(7):S15-25.

    Article  PubMed  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mahner S, Eulenburg C, Staehle A, Wegscheider K, Reuss A, Pujade-Lauraine E, et al. Prognostic impact of the time interval between surgery and chemotherapy in advanced ovarian cancer: analysis of prospective randomised phase III trials. Eur J Cancer. 2013;49(1):142–9.

    Article  CAS  PubMed  Google Scholar 

  17. Alexander M, Blum R, Burbury K, Coutsouvelis J, Dooley M, Fazil O, et al. Timely initiation of chemotherapy: a systematic literature review of six priority cancers—results and recommendations for clinical practice: time-to-chemotherapy and survival. Intern Med J. 2017;47(1):16–34.

    Article  CAS  PubMed  Google Scholar 

  18. Bun S, Yunokawa M, Ebata T, Kobayashi Kato M, Shimoi T, Kato T, et al. Feasibility of initial treatment in elderly patients with ovarian cancer in Japan: a retrospective study. Int J Clin Oncol. 2019;24(9):1111–8.

    Article  PubMed  Google Scholar 

  19. Seagle BLL, Butler SK, Strohl AE, Nieves-Neira W, Shahabi S. Chemotherapy delay after primary debulking surgery for ovarian cancer. Gynecol Oncol. 2017;144(2):260–5.

    Article  PubMed  Google Scholar 

  20. Singh S, Guetzko M, Resnick K. Preoperative predictors of delay in initiation of adjuvant chemotherapy in patients undergoing primary debulking surgery for ovarian cancer. Gynecol Oncol. 2016;143(2):241–5.

    Article  PubMed  Google Scholar 

  21. Baldewpersad Tewarie NMS, Van Driel WJ, Van Ham M, Wouters MW, Kruitwagen R, Kruse AJ, et al. Postoperative outcomes of primary and interval cytoreductive surgery for advanced ovarian cancer registered in the Dutch Gynecological Oncology Audit (DGOA). Gynecol Oncol. 2021;162(2):331–8.

    Article  CAS  PubMed  Google Scholar 

  22. Kengsakul M, Nieuwenhuyzen-de Boer GM, Udomkarnjananun S, Kerr SJ, Niehot CD, Van Beekhuizen HJ. Factors predicting postoperative morbidity after cytoreductive surgery for ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol. 2022;33(4):e53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kumar A, Janco JM, Mariani A, Bakkum-Gamez JN, Langstraat CL, Weaver AL, et al. Risk-prediction model of severe postoperative complications after primary debulking surgery for advanced ovarian cancer. Gynecol Oncol. 2016;140(1):15–21.

    Article  PubMed  Google Scholar 

  24. Wright JD, Ananth CV, Tsui J, Glied SA, Burke WM, Lu YS, et al. Comparative effectiveness of upfront treatment strategies in elderly women with ovarian cancer: Upfront Treatment for Ovarian Cancer. Cancer. 2014;120(8):1246–54.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynecologic Oncology, Max Institute of Cancer Care, Max Hospital, Saket, New Delhi, India

    Kanika Batra Modi

  2. Department of Medical Oncology, Max Institute of Cancer Care, Max Hospital, Saket, New Delhi, India

    Sandeep Batra, Shefali Sardana, Nagender Sharma & Shubham Pandey

  3. Department of Oncology and Onco-Surgery, Max Institute of Cancer Care, Max Hospital, Saket, New Delhi, India

    Harit Kumar Chaturvedi

Authors
  1. Kanika Batra Modi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandeep Batra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shefali Sardana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nagender Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shubham Pandey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Harit Kumar Chaturvedi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kanika Batra Modi.

Ethics declarations

Conflict of interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Batra Modi, K., Batra, S., Sardana, S. et al. An Audit on Factors Delaying Time to Chemotherapy in Stage IIB–IV Ovarian Cancer Patients After Primary Debulking Surgery. Indian J Gynecol Oncolog 22, 79 (2024). https://doi.org/10.1007/s40944-024-00843-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40944-024-00843-8

Keywords

Search

Navigation