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Factors affecting ovarian cancer treatment in the octogenarian patient population
Abstracts / Gynecologic Oncology 137S1 (2015) 180–209
weight in exercising mice compared to their sedentary counterparts (0.0812 g vs. 0.1195 g, P = 0.05). Omentin, a protective adipokine, was found in significantly higher serum concentrations among exercising mice than that among sedentary ones (5.051 ng/dL vs. 4.433 ng/dL, P = 0.04). This difference was most pronounced at 4 h a day, 7 days per week (6.434 ng/dL vs. 4.944 ng/dL, P = 0.03). Conclusions: Exercise may suppress tumor growth, especially when the frequency and duration are optimized. Omentin may serve as a relevant biomarker of tumor response to exercise and may be useful in ongoing human studies. Our research supports epidemiologic studies suggesting that exercise may be beneficial for women diagnosed with ovarian cancer and may potentially prolong the time to recurrence.
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oncologists because of bowel obstruction or colonic perforations. Twenty-one of 31 (68%) surgical patients subsequently received adjuvant chemotherapy at a mean of 28 days (range, 15–42 days) from surgery. Four perioperative deaths were noted, two of which were associated with bowel perforations. Of the 16 neoadjuvant chemotherapy patients, the reason for treatment was most commonly related to extent/stage of disease and performance status. Age was a factor in only one case and extensive comorbidities was a factor in three cases. Only seven (44%) patients underwent interval debulking. Mean progression-free survival for this octogenarian cohort was 21 months (range, 2–43 months) and overall survival was 34 months (range, 0–122 months). Conclusions: Octogenarians have a high perioperative death rate (10%), mostly associated with bowel perforations, and are less likely to undergo adjuvant chemotherapy after surgical resection. They are more likely to receive neoadjuvant chemotherapy because of poor performance status and advanced-stage disease. doi:10.1016/j.ygyno.2015.01.469
465 — Poster Session Cost effectiveness of primary debulking surgery when compared to neoadjuvant chemotherapy in the management of stages IIIC and IV epithelial ovarian cancer G.K. Fordea, J. Changb, A. Ziogasb, R.E. Bristowb. aUniversity of California at Irvine Medical Center, Orange, CA, USA, bUniversity of California, Irvine, Irvine, CA, USA
doi:10.1016/j.ygyno.2015.01.468
464 — Poster Session Factors affecting ovarian cancer treatment in the octogenarian patient population N. Rasool, T.E. Buekers, R.K. Hanna, A.R. Munkarah, S. Hensley Alford. Henry Ford Health System, Detroit, MI, USA Objectives: To identify treatment patterns, treatment decision factors, associated morbidity, and survival in women aged 80 and older with newly diagnosed ovarian cancer. Methods: A single-institution retrospective analysis of women 80 years of age and older treated for newly diagnosed ovarian cancer was performed. Data were abstracted on treatment received, comorbidities, and outcomes. Results: Forty-seven octogenarian patients were identified with newly diagnosed ovarian cancer. Median age was 83 years (range, 80– 94 years). Stage distribution was as follows: 7 stage I, 2 stage II, 22 stage III (18 stage IIIC), and 11 stage IV. Five patients were not staged or incompletely staged. Ninety-one percent had at least one comorbidity, 15% with a prior malignancy or synchronous primary, colon cancer being the most common. Thirty-one patients (66%) underwent primary surgical intervention, while 16 underwent neoadjuvant chemotherapy. Of the 31 patients undergoing surgery, 10 (32%) had suboptimal debulking, 4 (40%) of which were performed by non-gynecologic
Objectives: To examine the costs-effectiveness of primary debulking surgery (PDS) when compared to neoadjuvant chemotherapy (NACT) in the management of epithelial ovarian cancer (EOC) using Surveillance, Epidemiology, and End Results data linked to Medicare claims (SEER-Medicare). Methods: Using a Markov model, the cost-effectiveness of PDS was compared to that of NACT. We modeled cost and survival inputs using data from women in the SEER-Medicare database with ovarian cancer treated by either PDS or NACT between 1992 and 2009. Direct and indirect costs were discounted by an annual rate of 3%. Utility weights were obtained from published data. The incremental costeffectiveness ratio (ICER) of PDS compared to NACT was calculated. Results: In our model, women with stage IIIC EOC had a higher mean adjusted treatment cost for PDS when compared to NACT ($31,945 vs. $30,016) but yielded greater quality-adjusted life-years (QALYs) (1.79 vs. 1.69). The ICER was $19,359/QALY gained. Women with stage IV EOC had a higher mean adjusted treatment cost following PDS when compared to NACT ($31,869 vs. $27,338) but yielded greater QALYs (1.69 vs. 1.66). The ICER was $130,083/QALY gained. A sensitivity analysis showed that for both PDS and NACT, the ICER was sensitive to incremental changes in the utility weight. Conclusions: PDS is significantly more cost-effective for women with stage IIIC EOC when compared to NACT. In women with stage IV EOC, PDS is also more cost-effective, although the QALYs gained are much more costly and exceed a $50,000 willingness to pay. doi:10.1016/j.ygyno.2015.01.470
466 — Poster Session Poor prognosis after conservative surgery in stage I mucinous epithelial ovarian cancer P.S. Jung, S.W. Lee, J.Y. Park, D.S. Suh, D.Y. Kim, J.H. Kim, Y.M. Kim, Y.T. Kim, J.H. Nam. University of Ulsan College of Medicine, ASAN Medical Center, Seoul, Republic of Korea
weight in exercising mice compared to their sedentary counterparts (0.0812 g vs. 0.1195 g, P = 0.05). Omentin, a protective adipokine, was found in significantly higher serum concentrations among exercising mice than that among sedentary ones (5.051 ng/dL vs. 4.433 ng/dL, P = 0.04). This difference was most pronounced at 4 h a day, 7 days per week (6.434 ng/dL vs. 4.944 ng/dL, P = 0.03). Conclusions: Exercise may suppress tumor growth, especially when the frequency and duration are optimized. Omentin may serve as a relevant biomarker of tumor response to exercise and may be useful in ongoing human studies. Our research supports epidemiologic studies suggesting that exercise may be beneficial for women diagnosed with ovarian cancer and may potentially prolong the time to recurrence.
187
oncologists because of bowel obstruction or colonic perforations. Twenty-one of 31 (68%) surgical patients subsequently received adjuvant chemotherapy at a mean of 28 days (range, 15–42 days) from surgery. Four perioperative deaths were noted, two of which were associated with bowel perforations. Of the 16 neoadjuvant chemotherapy patients, the reason for treatment was most commonly related to extent/stage of disease and performance status. Age was a factor in only one case and extensive comorbidities was a factor in three cases. Only seven (44%) patients underwent interval debulking. Mean progression-free survival for this octogenarian cohort was 21 months (range, 2–43 months) and overall survival was 34 months (range, 0–122 months). Conclusions: Octogenarians have a high perioperative death rate (10%), mostly associated with bowel perforations, and are less likely to undergo adjuvant chemotherapy after surgical resection. They are more likely to receive neoadjuvant chemotherapy because of poor performance status and advanced-stage disease. doi:10.1016/j.ygyno.2015.01.469
465 — Poster Session Cost effectiveness of primary debulking surgery when compared to neoadjuvant chemotherapy in the management of stages IIIC and IV epithelial ovarian cancer G.K. Fordea, J. Changb, A. Ziogasb, R.E. Bristowb. aUniversity of California at Irvine Medical Center, Orange, CA, USA, bUniversity of California, Irvine, Irvine, CA, USA
doi:10.1016/j.ygyno.2015.01.468
464 — Poster Session Factors affecting ovarian cancer treatment in the octogenarian patient population N. Rasool, T.E. Buekers, R.K. Hanna, A.R. Munkarah, S. Hensley Alford. Henry Ford Health System, Detroit, MI, USA Objectives: To identify treatment patterns, treatment decision factors, associated morbidity, and survival in women aged 80 and older with newly diagnosed ovarian cancer. Methods: A single-institution retrospective analysis of women 80 years of age and older treated for newly diagnosed ovarian cancer was performed. Data were abstracted on treatment received, comorbidities, and outcomes. Results: Forty-seven octogenarian patients were identified with newly diagnosed ovarian cancer. Median age was 83 years (range, 80– 94 years). Stage distribution was as follows: 7 stage I, 2 stage II, 22 stage III (18 stage IIIC), and 11 stage IV. Five patients were not staged or incompletely staged. Ninety-one percent had at least one comorbidity, 15% with a prior malignancy or synchronous primary, colon cancer being the most common. Thirty-one patients (66%) underwent primary surgical intervention, while 16 underwent neoadjuvant chemotherapy. Of the 31 patients undergoing surgery, 10 (32%) had suboptimal debulking, 4 (40%) of which were performed by non-gynecologic
Objectives: To examine the costs-effectiveness of primary debulking surgery (PDS) when compared to neoadjuvant chemotherapy (NACT) in the management of epithelial ovarian cancer (EOC) using Surveillance, Epidemiology, and End Results data linked to Medicare claims (SEER-Medicare). Methods: Using a Markov model, the cost-effectiveness of PDS was compared to that of NACT. We modeled cost and survival inputs using data from women in the SEER-Medicare database with ovarian cancer treated by either PDS or NACT between 1992 and 2009. Direct and indirect costs were discounted by an annual rate of 3%. Utility weights were obtained from published data. The incremental costeffectiveness ratio (ICER) of PDS compared to NACT was calculated. Results: In our model, women with stage IIIC EOC had a higher mean adjusted treatment cost for PDS when compared to NACT ($31,945 vs. $30,016) but yielded greater quality-adjusted life-years (QALYs) (1.79 vs. 1.69). The ICER was $19,359/QALY gained. Women with stage IV EOC had a higher mean adjusted treatment cost following PDS when compared to NACT ($31,869 vs. $27,338) but yielded greater QALYs (1.69 vs. 1.66). The ICER was $130,083/QALY gained. A sensitivity analysis showed that for both PDS and NACT, the ICER was sensitive to incremental changes in the utility weight. Conclusions: PDS is significantly more cost-effective for women with stage IIIC EOC when compared to NACT. In women with stage IV EOC, PDS is also more cost-effective, although the QALYs gained are much more costly and exceed a $50,000 willingness to pay. doi:10.1016/j.ygyno.2015.01.470
466 — Poster Session Poor prognosis after conservative surgery in stage I mucinous epithelial ovarian cancer P.S. Jung, S.W. Lee, J.Y. Park, D.S. Suh, D.Y. Kim, J.H. Kim, Y.M. Kim, Y.T. Kim, J.H. Nam. University of Ulsan College of Medicine, ASAN Medical Center, Seoul, Republic of Korea