Completion of Adjuvant Chemotherapy and Use of Health Services for Older Women With Epithelial Ovarian Cancer Kathleen M. Fairfield, Kimberly Murray, F. Lee Lucas, Heidi R. Wierman, Craig C. Earle, Edward L. Trimble, Laurie Small, and Joan L. Warren Kathleen M. Fairfield, Kimberly Murray, F. Lee Lucas, Heidi R. Wierman, and Laurie Small, Maine Medical Center, Portland, ME; Craig C. Earle, Sunny- brook Health Sciences Centre, Toronto, Ontario, Canada; and Edward L. Trimble and Joan L. Warren, National Cancer Institute, Bethesda, MD. Submitted December 17, 2010; accepted June 30, 2011; published online ahead of print at www.jco.org on September 12, 2011. Supported by a grant from Maine Medi- cal Center’s Research Strategic Plan Program (K.M.F.). This study used the linked Surveillance, Epidemiology, and End Results (SEER) –Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. Authors’ disclosures of potential con- flicts of interest and author contribu- tions are found at the end of this article. Corresponding author: Kathleen Fairfield, MD, DrPH, Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Maine Medical Center, 22 Bramhall St, Portland, ME 04102; e-mail: fairfk@mmc.org. © 2011 by American Society of Clinical Oncology 0732-183X/11/2929-3921/$20.00 DOI: 10.1200/JCO.2010.34.1552 A B S T R A C T Purpose This analysis identifies factors associated with completion of adjuvant chemotherapy for patients with ovarian cancer and subsequent use of health services. Patients and Methods We used the Surveillance, Epidemiology, and End Results (SEER) –Medicare database to identify 4,617 women age 65 years or older with ovarian cancer diagnosed from 2001 to 2005. By using multivariable analyses with completion of chemotherapy as the outcome of interest, we describe factors associated with completion of treatment, including age, race, marital status, comorbidities, and sociodemographic factors. Use of health services was captured from Medicare claims. Results Among 4,617 patients with untreated ovarian cancer, 1,329 (28.8%) received no chemotherapy, 1,139 (24.7%) received a partial course of chemotherapy, and 2,149 (46.5%) completed chemo- therapy. Women age 75 years or older were at greater risk of incomplete chemotherapy versus women age 65 to 74 years (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.04). Having two or more comorbidities was also significantly associated with incomplete chemotherapy (OR, 1.83; 95% CI, 1.34 to 2.50). Among women who received either a partial or complete course of chemotherapy, we did not find an increase in use of health services (hospitalizations, emergency department visits, or physician visits) for the oldest women (age 80 years or older) compared with younger women. Conclusion There is considerable room for improvement in helping older patients with ovarian cancer initiate and complete chemotherapy. The oldest women who completed chemotherapy in this study did not use health services more than younger women did. Treatment teams for older pa- tients with ovarian cancer should include expertise in geriatric assessment, should carefully identify medical and psychosocial barriers to completing treatment, and should support patients throughout treatment. J Clin Oncol 29:3921-3926. © 2011 by American Society of Clinical Oncology INTRODUCTION As our population ages, the medical community is confronted with more aging patients seeking treat- ment for malignancies. Determining appropriate- ness of care to offer older patients depends on many factors. The average age at diagnosis for ovarian can- cer is 63 years, and ovarian cancer is the fourth most common cause of death from malignancies among US women, with 21,880 new cases expected in 2010. The majority (67% to 69%) of women are diagnosed with late-stage disease. 1 Randomized trials show survival benefits for patients with advanced ovarian cancer who receive adjuvant chemotherapy, partic- ularly platinum-based regimens. 2 However, not all eligible patients initiate chemotherapy, particularly those among the elderly. In a prior analysis of na- tional data from Surveillance, Epidemiology, and End Results (SEER) –Medicare, 3 only half of women older than age 65 years received chemotherapy con- taining platinum for their ovarian cancer, but those who received such a regimen had survival benefits similar to those in trials with younger women. Older women have consistently been shown to have less aggressive treatment and poorer survival compared with younger women, 4-11 despite the fact that some clinicians have suggested that age alone should not be a barrier to full treatment for ovarian cancer. 6 In addition to age, factors previously associated with failure to initiate chemotherapy include race, 10,11 comorbid illness, 9 specialty of the treating physi- cian, 12 and geographic locationof the patient. 13 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 29  NUMBER 29  OCTOBER 10 2011 © 2011 by American Society of Clinical Oncology 3921 Downloaded from ascopubs.org by 54.162.75.6 on July 12, 2022 from 054.162.075.006 Copyright © 2022 American Society of Clinical Oncology. All rights reserved.