Patterns of First-Line Systemic Therapy Delivery and Outcomes in Advanced Epithelial Ovarian Cancer in Ontario.

Aged Bevacizumab / therapeutic use Carcinoma, Ovarian Epithelial / drug therapy Cohort Studies Female Humans Ontario Ovarian Neoplasms / drug therapy
bevacizumab health care utilization ovarian cancer real-world evidence

Journal

Current oncology (Toronto, Ont.)
ISSN: 1718-7729
Titre abrégé: Curr Oncol
Pays: Switzerland
ID NLM: 9502503

Informations de publication

Date de publication:
22 08 2022
Historique:
received: 18 07 2022
revised: 12 08 2022
accepted: 16 08 2022
entrez: 25 8 2022
pubmed: 26 8 2022
medline: 27 8 2022
Statut: epublish

Résumé

First-line treatment of epithelial ovarian cancer (EOC) consists of a combination of cytoreductive surgery and platinum-based chemotherapy. Recently, targeted therapies such as bevacizumab have been shown to improve oncologic outcomes in a subset of a high-risk population. The objective of this study is to evaluate the patterns of practice and outcomes of first-line systemic treatment of advanced EOC, focusing on the adoption of bevacizumab. A population cohort study was conducted using administrative data in Ontario, Canada. Patients diagnosed with advanced stage non-mucinous EOC between 2014 and 2018 were identified. Datasets were linked to obtaining information on first-line treatment including surgery, systemic therapy, providers of care, systemic therapy facilities, and acute care utilization (emergency department (ED) visits and hospitalizations) during systemic treatment. Multivariate logistic regression was used to determine factors associated with systemic therapy utilization. Among 3726 patients with advanced EOC, 2838 (76%) received chemotherapy: 1316 (47%) received neoadjuvant chemotherapy, 1060 (37%) underwent primary cytoreductive surgery followed by chemotherapy, and 462 (16%) received chemotherapy only. The median age was 67 (range: 20-100). Most chemotherapies were prescribed by gynecologic oncologists (60%) and in level 1 academic cancer centres (58%). Only 54 patients (3.1%) received bevacizumab in the first-line setting after its approval in Ontario in 2016. Bevacizumab was more likely to be administered by medical oncologists compared to gynecologic oncologists (OR 3.95, 95% CI 2.11-7.14). In total, 1561 (55%) and 1594 (56%) patients had at least one ED visit and/or hospitalization during systemic treatment, respectively. The most common reasons for ED visits were fever and bowel obstruction. Patterns of care for EOC in Ontario differed between care providers. The uptake of bevacizumab for first-line treatment of EOC was low. Acute care utilization related to EOC was high.

Sections du résumé

BACKGROUND
First-line treatment of epithelial ovarian cancer (EOC) consists of a combination of cytoreductive surgery and platinum-based chemotherapy. Recently, targeted therapies such as bevacizumab have been shown to improve oncologic outcomes in a subset of a high-risk population. The objective of this study is to evaluate the patterns of practice and outcomes of first-line systemic treatment of advanced EOC, focusing on the adoption of bevacizumab.
METHODS
A population cohort study was conducted using administrative data in Ontario, Canada. Patients diagnosed with advanced stage non-mucinous EOC between 2014 and 2018 were identified. Datasets were linked to obtaining information on first-line treatment including surgery, systemic therapy, providers of care, systemic therapy facilities, and acute care utilization (emergency department (ED) visits and hospitalizations) during systemic treatment. Multivariate logistic regression was used to determine factors associated with systemic therapy utilization.
RESULTS
Among 3726 patients with advanced EOC, 2838 (76%) received chemotherapy: 1316 (47%) received neoadjuvant chemotherapy, 1060 (37%) underwent primary cytoreductive surgery followed by chemotherapy, and 462 (16%) received chemotherapy only. The median age was 67 (range: 20-100). Most chemotherapies were prescribed by gynecologic oncologists (60%) and in level 1 academic cancer centres (58%). Only 54 patients (3.1%) received bevacizumab in the first-line setting after its approval in Ontario in 2016. Bevacizumab was more likely to be administered by medical oncologists compared to gynecologic oncologists (OR 3.95, 95% CI 2.11-7.14). In total, 1561 (55%) and 1594 (56%) patients had at least one ED visit and/or hospitalization during systemic treatment, respectively. The most common reasons for ED visits were fever and bowel obstruction.
CONCLUSION
Patterns of care for EOC in Ontario differed between care providers. The uptake of bevacizumab for first-line treatment of EOC was low. Acute care utilization related to EOC was high.

Identifiants

DOI: 10.3390/curroncol29080472 PMID: 36005210 PMC: PMC9406672
pubmed: 36005210
pii: curroncol29080472
doi: 10.3390/curroncol29080472
pmc: PMC9406672
doi:

Substances chimiques

Bevacizumab 2S9ZZM9Q9V

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

5988-6009

Références

Int J Oncol. 2021 Jul;59(1):
pubmed: 34132354
Lancet Oncol. 2015 Aug;16(8):928-36
pubmed: 26115797
N Engl J Med. 2011 Dec 29;365(26):2484-96
pubmed: 22204725
J Clin Oncol. 2007 Apr 1;25(10):1169-75
pubmed: 17401005
Gynecol Oncol. 2017 Jun;145(3):500-507
pubmed: 28366545
J Clin Oncol. 2012 Jun 10;30(17):2039-45
pubmed: 22529265
Cancer. 2016 Oct 15;122(20):3175-3182
pubmed: 27391466
J Clin Oncol. 2014 May 1;32(13):1302-8
pubmed: 24637997
Int J Gynecol Cancer. 2017 May;27(4):675-683
pubmed: 28328580
Int J Gynecol Cancer. 2015 May;25(4):551-8
pubmed: 25756401
Gynecol Oncol. 2010 Apr;117(1):18-22
pubmed: 20106512
J Oncol Pract. 2015 Mar;11(2):126-32
pubmed: 25604597
Lancet. 2019 Mar 23;393(10177):1240-1253
pubmed: 30910306
J Clin Oncol. 2000 Jun;18(11):2327-40
pubmed: 10829054
JAMA Oncol. 2017 Jan 01;3(1):76-82
pubmed: 27892998
Obstet Gynecol Clin North Am. 2012 Jun;39(2):107-29
pubmed: 22640706
Gynecol Oncol. 2005 Nov;99(2):447-61
pubmed: 16126262
CA Cancer J Clin. 2021 Jan;71(1):7-33
pubmed: 33433946
Gynecol Oncol. 2022 Mar;164(3):522-528
pubmed: 35063277
N Engl J Med. 2019 Dec 19;381(25):2416-2428
pubmed: 31851799
N Engl J Med. 2011 Dec 29;365(26):2473-83
pubmed: 22204724
Curr Oncol. 2009 Jan;16(1):4-15
pubmed: 19229367
N Engl J Med. 2018 Dec 27;379(26):2495-2505
pubmed: 30345884
Cochrane Database Syst Rev. 2021 Feb 5;2:CD005343
pubmed: 33543776
J Natl Cancer Inst. 2006 Feb 1;98(3):172-80
pubmed: 16449677
N Engl J Med. 2006 Jan 5;354(1):34-43
pubmed: 16394300
Gynecol Oncol. 2021 May;161(2):601-612
pubmed: 33546867
J Clin Oncol. 2016 Oct 1;34(28):3460-73
pubmed: 27502591

Auteurs

Shiru L Liu (SL)

Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
Department of Medical Oncology, BC Cancer-Surrey, Surrey, BC V3V 1Z2, Canada.
ORCID: 0000-0002-9099-5309

Wing C Chan (WC)

ICES, Toronto, ON M4N 3M5, Canada.

Geneviève Bouchard-Fortier (G)

Division of Gynecology Oncology, University Health Network (UHN)/Sinai Health System, Toronto, ON M5G 2C1, Canada.
Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada.

Stephanie Lheureux (S)

Division of Medical Oncology, University Health Network (UHN), Toronto, ON M5G 2C1, Canada.

Sarah E Ferguson (SE)

Division of Gynecology Oncology, University Health Network (UHN)/Sinai Health System, Toronto, ON M5G 2C1, Canada.
Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada.

Monika K Krzyzanowska (MK)

Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
ICES, Toronto, ON M4N 3M5, Canada.
Division of Medical Oncology, University Health Network (UHN), Toronto, ON M5G 2C1, Canada.
ORCID: 0000-0001-5533-7418

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Patterns of First-Line Systemic Therapy...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Globulines › Sérum-globulines › Immunoglobulines › Anticorps › Anticorps monoclonaux › Anticorps monoclonaux humanisés › Bévacizumab › Patterns of First-Line Systemic Therapy...
questionsmedicales.fr › Maladies endocriniennes › Troubles gonadiques › Maladies ovariennes › Tumeurs de l'ovaire › Carcinome épithélial de l'ovaire › Patterns of First-Line Systemic Therapy...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Patterns of First-Line Systemic Therapy...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Patterns of First-Line Systemic Therapy...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › Patterns of First-Line Systemic Therapy...
questionsmedicales.fr › Maladies endocriniennes › Troubles gonadiques › Maladies ovariennes › Tumeurs de l'ovaire › Patterns of First-Line Systemic Therapy...