Toxicity of intraperitoneal chemotherapy may be related to age in women treated for optimally debulked ovarian cancer

Impact of shifting from office- to hospital-based treatment facilities on the administration of intraperitoneal chemotherapy for ovarian cancer

INTRODUCTION

Cancer chemotherapy in the United States has been delivered mostly in an office-based setting since the late 1980s. However, in the past 5 years, more patients have been treated in hospitals as a result of reimbursement changes. Intraperitoneal (IP) chemotherapy for ovarian cancer has been similarly affected. This report examines changes in care of women treated with IP chemotherapy in an office- versus hospital-based setting.

METHODS

Over 10 years, 140 women with ovarian cancer were identified as candidates for IP chemotherapy. Of these patients, 92 were treated in an oncology-dedicated infusion center in the office of a physicians' group; 48 were treated in a local hospital. Location was determined based on insurance coverage and reimbursement. Data collected included demographics, number of treatment cycles completed, length of each treatment, and adverse events.

RESULTS

The age and ethnicity of patients treated in the office versus hospital were similar. All six doses of intravenous IP chemotherapy were completed by 73 (79%) of 92 patients treated in the office versus 23 (48%) of 48 patients treated in the hospital (P < .001). The time of each infusion was longer in the hospital-versus office-based setting (P < .001). There were more adverse events associated with treatment in the hospital.

CONCLUSION

IP chemotherapy is associated with worse outcomes in the hospital- compared with office-based setting. The reason seems to involve a relative lack of resources directed specifically to chemotherapy administration. If current reimbursement trends continue, this could result in decreased survival for women with ovarian cancer.

Office-based intraperitoneal chemotherapy for ovarian cancer

The challenges and opportunities when implementing an office-based intraperitoneal chemotherapy program.

Paclitaxel maintenance chemotherapy following intraperitoneal chemotherapy for ovarian cancer

The aim of this study was to determine the feasibility of two treatment regimens for ovarian cancers: (1) combined intraperitoneal/intravenous (IP/IV) cisplatin/paclitaxel; or (2) IV only carboplatin/paclitaxel; both followed by 12 cycles of maintenance paclitaxel. A total of 102 subjects were identified who underwent surgery for stage III ovarian cancer. All subjects received either IV or IV/IP chemotherapy, and had a complete response. The subjects were then prescribed maintenance paclitaxel IV for an additional 12 months. Demographic and clinical data were analyzed. Forty-five subjects received combined IP/IV chemotherapy versus 57 who received IV therapy alone. IP/IV versus IV administration was not associated with differences in age, ethnicity, tumor histology, or incidence of intestinal surgery. Toxicities included fatigue, neuropathy, myelosuppression, and nausea/vomiting in both groups. In the IP/IV group, 29/47 subjects (61.7%) completed 12 cycles of maintenance paclitaxel versus 18/55 (32.7%) in the IV group (P = 0.006). The mean number completed by the IP/IV group was 8.6, while the IV group completed 5.8 cycles (P = 0.002). In subjects who received <12 cycles, the mean number of cycles completed by the IP/IV group was 3.1 versus 2.8 in the IV group. The reasons for stopping included neuropathy (33), fatigue (8), myelosuppression (7) and disease progression (6). Patients who received combined IP/IV chemotherapy were more likely to complete maintenance therapy than those who only received IV chemotherapy. Patients who stop maintenance therapy usually do so early in the course. Additional resources directed at physical and emotional support during early cycles of maintenance chemotherapy may allow more to complete the regimen.