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Clinical indicators useful in decision-making about palliative chemotherapy for end-of-life ovarian cancer patients

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Chemotherapy for end-of-life ovarian cancer patients is a complex and delicate problem. We evaluated whether active palliative chemotherapy is beneficial for such patients using inflammatory parameters, nutritional indicators, and the PPI (Palliative Prognostic Index), which predicts short-term prognosis.

Methods

Thirty-six patients among 49 patients who died from ovarian cancer from 2014 to 2019 at our hospital were enrolled, whom clinical and laboratory data just before starting their final chemotherapy regimen could be obtained. Associations between the time from last chemotherapy to death and the following parameters were investigated: age, performance status, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, Modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI) score, and PPI score.

Results

The median age was 57 (range 19–80) years. The median time from last chemotherapy to death was 45.5 (range 11–110) days. Eight patients (22%) died within 30 days of their last chemotherapy regimen. In univariate analysis, median survival time was significantly shorter in patients with higher NLR, mGPS 2, and higher PPI values; NLR (≥ median vs. < median): 32 (range 11–80) days vs. 54 (range 35–110) days, p = 0.008; mGPS (2 vs. 0–1): 42 (range 11–80) days vs. 96 (range 49–110) days, p = 0.012; and PPI score (≥ median vs. < median): 38 (range 11–74) days vs. 60 (range 18–110) days, p = 0.005. However, in multivariate analysis, no factors were identified as independent prognostic factors for survival.

Conclusion

Parameters, such as NLR, mGPS, and PPI score, may be indicators for discontinuation of palliative chemotherapy, and may be useful for maximizing end-of-life care for ovarian cancer patients.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan

    Kaori Kiuchi, Kiyoshi Hasegawa, Mariko Watanabe, Emi Motegi, Nobuaki Kosaka & Ichio Fukasawa

  2. Department of Obstetrics and Gynecology, Inuyama Chuo General Hospital, 6 Futakotsuka Goroumaru, Inuyama, Aichi, 484-8511, Japan

    Kiyoshi Hasegawa

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  1. Kaori Kiuchi
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  2. Kiyoshi Hasegawa
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Contributions

KK; data collection and drafting of the manuscript and first author. KH; corresponding author, supervision. MW; acquisition of data, especially clinical data and course. EM; acquisition of data, especially clinical data and course. NK; acquisition of data, especially clinical data and course. IF; supervision throughout this manuscript.

Corresponding author

Correspondence to Kiyoshi Hasegawa.

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Conflict of interest

We declare that we have no conflict of interest.

Ethical approval

The study protocol was approved by the institutional ethical committee of Dokkyo Medical University. All procedures performed in this study were in accordance with the ethical standards of the institutional ethical committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

This study was approved by the institutional ethical committee of Dokkyo Medical University, and written informed consents was waived because of retrospective design. This policy was accepted by the institutional ethical committee on the condition that a document that declares an opt-out policy by which any patients' relatives could refuse to be included in this study was uploaded on the Web page.

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Kiuchi, K., Hasegawa, K., Watanabe, M. et al. Clinical indicators useful in decision-making about palliative chemotherapy for end-of-life ovarian cancer patients. Arch Gynecol Obstet 305, 425–430 (2022). https://doi.org/10.1007/s00404-021-06162-z

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  • DOI: https://doi.org/10.1007/s00404-021-06162-z

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