Time to adjuvant chemotherapy and overall survival in advanced-stage ovarian cancer patients in England: a population-based retrospective cohort study
Background and purpose: In advanced ovarian cancer, delayed time to chemotherapy (TTC) has been associated with poorer survival outcomes; evidence is conflicting, however. This study investigated the impact of patient demographic factors on TTC and assessed whether TTC was associated with 5-year ove...
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Elsevier
2025-06-01
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| Series: | ESMO Real World Data and Digital Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949820125000323 |
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| author | L. Steventon S. Nicum K. Man D. Dodwell Z. Wang A. Patel B. Pickwell-Smith L. Wei P. Chambers |
| author_facet | L. Steventon S. Nicum K. Man D. Dodwell Z. Wang A. Patel B. Pickwell-Smith L. Wei P. Chambers |
| author_sort | L. Steventon |
| collection | DOAJ |
| description | Background and purpose: In advanced ovarian cancer, delayed time to chemotherapy (TTC) has been associated with poorer survival outcomes; evidence is conflicting, however. This study investigated the impact of patient demographic factors on TTC and assessed whether TTC was associated with 5-year overall survival. Materials and methods: A retrospective cohort study was conducted using English national data for women with advanced-stage ovarian cancer (IIB-IV), treated with primary debulking surgery (PDS) or interval debulking surgery (IDS) + adjuvant carboplatin/paclitaxel chemotherapy between 1 January 2014 and 31 December 2019. Cox proportional hazards regression was used to compare the primary outcome of 5-year overall survival between patients treated within ≤6 weeks (0-42 days) or >6 weeks (>42 days) of surgery. Results: A total of 4619 patients were included. Of these, 42% (n = 1940) received PDS and 58% (n = 2679) IDS. Median TTC was 45 days [interquartile range (IQR) 37-55 days] for PDS and 34 days (IQR 27-42 days) for IDS. TTC ≤6 weeks was associated with 5-year survival in the IDS cohort (HR 1.18, 95% CI 1.06-1.33, P = 0.003), but not in the PDS cohort (HR 1.04, 95% CI 0.90-1.21, P = 0.6). A higher proportion of patients from the most socioeconomically deprived backgrounds waited >6 weeks (45%, n = 291) compared with the least deprived (37%, n = 398). Adjuvant chemotherapy was initiated in 72% of patients in London within ≤6 weeks compared with 47% in the North West. Conclusions: Median TTC exceeded 4-week guidance from the European Society of Medical Oncology. TTC >6 weeks was associated with reduced 5-year survival in patients treated with interval surgery, but not primary surgery. Regional disparities in TTC were observed. |
| format | Article |
| id | doaj-art-bbc2b204a4e44e499b1edc5c2667f048 |
| institution | Kabale University |
| issn | 2949-8201 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | ESMO Real World Data and Digital Oncology |
| spelling | doaj-art-bbc2b204a4e44e499b1edc5c2667f0482025-08-20T03:53:38ZengElsevierESMO Real World Data and Digital Oncology2949-82012025-06-01810014310.1016/j.esmorw.2025.100143Time to adjuvant chemotherapy and overall survival in advanced-stage ovarian cancer patients in England: a population-based retrospective cohort studyL. Steventon0S. Nicum1K. Man2D. Dodwell3Z. Wang4A. Patel5B. Pickwell-Smith6L. Wei7P. Chambers8Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; University College London Hospital NHS Foundation Trust, London, UKUniversity College London Hospital NHS Foundation Trust, London, UKResearch Department of Practice and Policy, UCL School of Pharmacy, London, UKNuffield Department of Population Health, University of Oxford, Oxford, UKNuffield Department of Population Health, University of Oxford, Oxford, UKUniversity College London Hospital NHS Foundation Trust, London, UKLeeds Teaching Hospitals NHS Trust, Leeds, UKResearch Department of Practice and Policy, UCL School of Pharmacy, London, UKResearch Department of Practice and Policy, UCL School of Pharmacy, London, UK; University College London Hospital NHS Foundation Trust, London, UK; Correspondence to: Dr Pinkie Chambers, Pharmacy Department, University College London Hospital, 235 Euston Road, London NW1 2BU, UK. Tel: 02081387965Background and purpose: In advanced ovarian cancer, delayed time to chemotherapy (TTC) has been associated with poorer survival outcomes; evidence is conflicting, however. This study investigated the impact of patient demographic factors on TTC and assessed whether TTC was associated with 5-year overall survival. Materials and methods: A retrospective cohort study was conducted using English national data for women with advanced-stage ovarian cancer (IIB-IV), treated with primary debulking surgery (PDS) or interval debulking surgery (IDS) + adjuvant carboplatin/paclitaxel chemotherapy between 1 January 2014 and 31 December 2019. Cox proportional hazards regression was used to compare the primary outcome of 5-year overall survival between patients treated within ≤6 weeks (0-42 days) or >6 weeks (>42 days) of surgery. Results: A total of 4619 patients were included. Of these, 42% (n = 1940) received PDS and 58% (n = 2679) IDS. Median TTC was 45 days [interquartile range (IQR) 37-55 days] for PDS and 34 days (IQR 27-42 days) for IDS. TTC ≤6 weeks was associated with 5-year survival in the IDS cohort (HR 1.18, 95% CI 1.06-1.33, P = 0.003), but not in the PDS cohort (HR 1.04, 95% CI 0.90-1.21, P = 0.6). A higher proportion of patients from the most socioeconomically deprived backgrounds waited >6 weeks (45%, n = 291) compared with the least deprived (37%, n = 398). Adjuvant chemotherapy was initiated in 72% of patients in London within ≤6 weeks compared with 47% in the North West. Conclusions: Median TTC exceeded 4-week guidance from the European Society of Medical Oncology. TTC >6 weeks was associated with reduced 5-year survival in patients treated with interval surgery, but not primary surgery. Regional disparities in TTC were observed.http://www.sciencedirect.com/science/article/pii/S2949820125000323cancerovariansurgeryadjuvant chemotherapytreatment equity |
| spellingShingle | L. Steventon S. Nicum K. Man D. Dodwell Z. Wang A. Patel B. Pickwell-Smith L. Wei P. Chambers Time to adjuvant chemotherapy and overall survival in advanced-stage ovarian cancer patients in England: a population-based retrospective cohort study ESMO Real World Data and Digital Oncology cancer ovarian surgery adjuvant chemotherapy treatment equity |
| title | Time to adjuvant chemotherapy and overall survival in advanced-stage ovarian cancer patients in England: a population-based retrospective cohort study |
| title_full | Time to adjuvant chemotherapy and overall survival in advanced-stage ovarian cancer patients in England: a population-based retrospective cohort study |
| title_fullStr | Time to adjuvant chemotherapy and overall survival in advanced-stage ovarian cancer patients in England: a population-based retrospective cohort study |
| title_full_unstemmed | Time to adjuvant chemotherapy and overall survival in advanced-stage ovarian cancer patients in England: a population-based retrospective cohort study |
| title_short | Time to adjuvant chemotherapy and overall survival in advanced-stage ovarian cancer patients in England: a population-based retrospective cohort study |
| title_sort | time to adjuvant chemotherapy and overall survival in advanced stage ovarian cancer patients in england a population based retrospective cohort study |
| topic | cancer ovarian surgery adjuvant chemotherapy treatment equity |
| url | http://www.sciencedirect.com/science/article/pii/S2949820125000323 |
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