The Effect of Delayed Chemotherapy on the Decrease of CA125 in Epithelial Ovarian Cancer During Coronavirus Disease Pandemic in 2020

The impact of inter-cycle treatment delays on overall survival in patients with advanced-stage ovarian cancer

INTRODUCTION

Chemotherapy forms the cornerstone of systemic treatment for advanced ovarian cancer, extending overall survival; however, drug-related toxicity can lead to treatment delays, potentially diminishing treatment efficacy. This study evaluated the impact of treatment delays on all-cause mortality of patients with ovarian cancer, to better inform decisions on patient management.

METHODS

This retrospective, population-based cohort study included 1517 women with advanced-stage ovarian cancer, receiving first-line adjuvant or neoadjuvant chemotherapy in 2014 and 2015. The frequency of inter-cycle delays >7 days was calculated using drug administration dates. Kaplan-Meier estimates were used to compare 2-year overall survival (OS) between patients who were delayed and those treated to schedule. Cox proportional hazards regression was used to investigate the impact of treatment delay on all-cause mortality. Inverse probability of treatment weighting propensity scores were used to adjust for confounding variables.

RESULTS

Delays >7 days occurred in 35.3% of patients. Two-year OS probability was 62.7% in patients who experienced treatment delays >7 days (95% CI, 58.7-66.9) compared to 69.1% in those treated to schedule (95% CI, 66.2-72.0). Delays were not significantly associated with all-cause mortality when adjusted for confounders (HR 1.00 95% CI, 0.83-1.20, P = .9).

CONCLUSIONS

Delays to chemotherapy treatment were not significantly associated with worsened survival in patients with advanced-stage ovarian cancer. These results can inform clinical decision making that prioritize toxicity management and quality of life for those treated with chemotherapy.

Impact of Treatment Delay on the Prognosis of Patients with Ovarian Cancer: A Population-based Study Using the Surveillance, Epidemiology, and End Results Database

Purpose: This study aimed to assess the impact of treatment delay on prognosis in patients with ovarian cancer. Methods: A retrospective analysis of patients with ovarian cancer in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 was performed. Chi-square tests were used to assess baseline differences. The Kaplan-Meier method was used to evaluate the effect of different treatment intervals on survival outcomes in patients. Cox regression analyses were used to identify independent factors associated with ovarian cancer prognosis. Results: Of the 21,590 patients included, 15,675 (72.6%), 5,582 (25.9%), and 333 (1.54%) were classified into the immediate-treatment (<1 month after diagnosis), intermediate-delay (1-2 month delayed), and long-delay groups (≥3 months delayed), respectively. The 5-year probability of overall survival (OS) was 61.4% in the immediate-treatment group, decreasing to 36.4% and 34.8% in the intermediate- and long-delay groups, respectively. Similar survival differences were also reflected in cancer-specific survival (CSS), with 5-year CSS probabilities of 66.7%, 42.6%, and 41.8% in the aforementioned groups, respectively. Patients in the intermediate-delay group showed poorer OS (adjusted hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02-1.11; p=0.006) and CSS (adjusted HR, 1.06; 95% CI, 1.01-1.11; p=0.012) than immediate-treatment group. Conclusions: Patients with delayed treatment had poorer OS and CSS. The patient's waiting time from diagnosis to initial treatment should be within 1 month.