Ovarian Cancer and Comorbidity: Is Poor Survival Explained by Choice of Primary Treatment or System Delay?

TY - JOUR

T1 - Ovarian Cancer and Comorbidity

T2 - Is Poor Survival Explained by Choice of Primary Treatment or System Delay?

AU - Noer, Mette Calundann

AU - Sperling, Cecilie Dyg

AU - Ottesen, Bent

AU - Antonsen, Sofie Leisby

AU - Christensen, Ib Jarle

AU - Høgdall, Claus

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objectives Comorbidity influences survival in ovarian cancer, but the causal relations between prognosis and comorbidity are not well characterized. The aim of this study was to investigate the associations between comorbidity, system delay, the choice of primary treatment, and survival in Danish ovarian cancer patients. Methods This population-based study was conducted on data from 5317 ovarian cancer patients registered in the Danish Gynecological Cancer Database. Comorbidity was classified according to the Charlson Comorbidity Index and the Ovarian Cancer Comorbidity Index. Pearson χ 2 test and multivariate logistic regression analyses were used to investigate the association between comorbidity and primary outcome measures: primary treatment ('primary debulking surgery' vs 'no primary surgery') and system delay (more vs less than required by the National Cancer Patient Pathways [NCPPs]). Cox regression analyses, including hypothesized mediators stepwise, were used to investigate if the impact of comorbidity on overall survival is mediated by the choice of treatment or system delay. Results A total of 3945 patients (74.2%) underwent primary debulking surgery, whereas 1160 (21.8%) received neoadjuvant chemotherapy. When adjusting for confounders, comorbidity was not significantly associated to the choice of treatment. Surgically treated patients with moderate/severe comorbidity were more often experiencing system delay longer than required by the NCPP. No association between comorbidity and system delay was observed for patients treated with neoadjuvant chemotherapy. Survival analyses demonstrated that system delay longer than NCPP requirement positively impacts survival (hazard ratio, 0.90 [95% confidence interval, 0.82-0.98]), whereas primary treatment modality has no significant impact on survival. Conclusions Patients with moderate/severe comorbidity experience often a longer system delay than patients with no or mild comorbidity. Age, stage, and comorbidity are factors influencing the choice of treatment, with stage being the most important factor and comorbidity of lesser importance. The impact of comorbidity on survival does not seem to be mediated by the choice of treatment or system delay.

AB - Objectives Comorbidity influences survival in ovarian cancer, but the causal relations between prognosis and comorbidity are not well characterized. The aim of this study was to investigate the associations between comorbidity, system delay, the choice of primary treatment, and survival in Danish ovarian cancer patients. Methods This population-based study was conducted on data from 5317 ovarian cancer patients registered in the Danish Gynecological Cancer Database. Comorbidity was classified according to the Charlson Comorbidity Index and the Ovarian Cancer Comorbidity Index. Pearson χ 2 test and multivariate logistic regression analyses were used to investigate the association between comorbidity and primary outcome measures: primary treatment ('primary debulking surgery' vs 'no primary surgery') and system delay (more vs less than required by the National Cancer Patient Pathways [NCPPs]). Cox regression analyses, including hypothesized mediators stepwise, were used to investigate if the impact of comorbidity on overall survival is mediated by the choice of treatment or system delay. Results A total of 3945 patients (74.2%) underwent primary debulking surgery, whereas 1160 (21.8%) received neoadjuvant chemotherapy. When adjusting for confounders, comorbidity was not significantly associated to the choice of treatment. Surgically treated patients with moderate/severe comorbidity were more often experiencing system delay longer than required by the NCPP. No association between comorbidity and system delay was observed for patients treated with neoadjuvant chemotherapy. Survival analyses demonstrated that system delay longer than NCPP requirement positively impacts survival (hazard ratio, 0.90 [95% confidence interval, 0.82-0.98]), whereas primary treatment modality has no significant impact on survival. Conclusions Patients with moderate/severe comorbidity experience often a longer system delay than patients with no or mild comorbidity. Age, stage, and comorbidity are factors influencing the choice of treatment, with stage being the most important factor and comorbidity of lesser importance. The impact of comorbidity on survival does not seem to be mediated by the choice of treatment or system delay.

KW - Adolescent

KW - Adult

KW - Aged

KW - Chemotherapy, Adjuvant

KW - Cohort Studies

KW - Comorbidity

KW - Denmark/epidemiology

KW - Female

KW - Humans

KW - Middle Aged

KW - Models, Statistical

KW - Neoadjuvant Therapy

KW - Neoplasm Staging

KW - Ovarian Neoplasms/drug therapy

KW - Prognosis

KW - Proportional Hazards Models

KW - Time-to-Treatment/statistics & numerical data

KW - Young Adult

U2 - 10.1097/IGC.0000000000001001

DO - 10.1097/IGC.0000000000001001

M3 - Journal article

C2 - 28604447

SN - 1048-891X

VL - 27

SP - 1123

EP - 1133

JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

IS - 6

ER -