- Email: [email protected]
Dose delay, but not dose reduction, in chemotherapy administration is associated with decreased survival in elderly women with ovarian cancer
32
Abstracts / Gynecologic Oncology 133 (2014) 2–207
both. Significant reductions were noted between pre- and postintervention BMI (34.9 ± 8.7 vs 33.9 ± 8.4, P = 0.0005), body weight (92.3 ± 23.7 kg vs 90.1 ± 22.9 kg, P b 0.0001), and WC (102.7 ± 14.9 cm vs 98.3 ± 15.1 cm, P = 0.0006). A trend toward significance was noted between pre- and postintervention total WEL scores (93.8 ± 41.1 vs 115.1 ± 48.1, P = 0.08). There was a moderate positive correlation between total WEL scores and the amount of health care provider feedback and push notifications (r = +0.349, P = 0.382). Conclusions: These results indicate that a lifestyle intervention application is a feasible option by which to elicit short-term reductions of BMI and WC by 3% to 4%. Although these results parallel the recent SUCCEED (Survivors of Uterine Cancer Empowered by Exercise and healthy Diet) trial, it is notable that they were achieved without encumbering cost and barrier-access issues. We will continue to enroll patients until we achieve 50 completers. doi:10.1016/j.ygyno.2014.03.098
79 - Focused Plenary Metformin and the risk of endometrial cancer: A population-based cohort study E.M. Ko1,2, T. Sturmer2, J.L. Hong2, W. Camelo2, V.L. Bae-Jump3, M.J. Funk2. 1 University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA, 2 University of North Carolina Gillings School of Public Health, Chapel Hill, NC, USA, 3University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Objectives: Metformin may decrease the risk of developing cancer, but its role in gynecologic cancers is not yet clear. We sought to compare whether women who initiate treatment with metformin vs sulfonylureas had a lower risk of endometrial cancer. Methods: A retrospective cohort analysis was performed using Truven Health Analytics MarketScan® Databases from 2000 to 2011. We identified new users of metformin or sulfonylureas and estimated HR and 95% CI with Cox Proportional Hazards, using an as-treated analytic approach. Stabilized inverse probability of treatment weights (IPTW) were used to adjust for potential confounders. Crude and IPTW-adjusted survival curves were estimated using the Kaplan–Meier method. Results: Of 541,128 eligible women, 456,838 (84%) initiated metformin and 84,290 (16%) initiated sulfonylurea. Baseline covariates, including age, diabetes, polycystic ovarian syndrome, and endometrial hyperplasia, differed between metformin and sulfonylurea users. Over a median follow-up of 1.2 years (interquartile range [IQR] 0.4–2.3) and a total follow-up of 2,030,914 person-years, 729 women developed endometrial cancer. Metformin use appeared to reduce the risk of endometrial cancer in the unadjusted analysis (HR 0.81, 95% CI 0.67–0.97). However, after balancing all baseline covariates using IPTW, metformin did not decrease the risk of endometrial cancer (HR 1.09, 95% CI 0.88–1.35). Multiple subgroup analyses in diabetic patients and varying age groups revealed similar nonprotective findings. Conclusions: In this population-based cohort of more than 500,000 women, initiating antidiabetic therapy with metformin compared with sulfonylureas was not associated with the risk of developing endometrial cancer. Further studies may determine if metformin may help reduce endometrial cancer in other subsets of particularly high-risk women.
80 – Featured Poster Dose delay, but not dose reduction, in chemotherapy administration is associated with decreased survival in elderly women with ovarian cancer N. Joseph1,2, R.M. Clark1,2, M. Lee1, K. Kopecky2, D.S. Dizon1,2, W.B. Growdon1. 1Brigham and Women's Hospital, Boston, MA, USA, 2 Harvard University, Boston, MA, USA. Objectives: Elderly patients with ovarian cancer represent a vulnerable population that frequently demonstrates poor outcomes. The objective of this study was to characterize risk factors and treatment patterns in this population and how they relate to overall survival (OS). Methods: After obtaining institutional review board approval, we identified all patients N65 years with stages II–IV epithelial ovarian cancer who underwent cytoreduction at our institution between the years of 2003 and 2011. Relevant clinical variables were extracted and correlated with OS. Statistical analysis was performed using logistic regression, Kaplan–Meier curves, and multivariable Cox proportional hazard models. Results: A total of 184 patients were included in the analysis. The average age was 73 years and median ASA class was 2. Seventy-eight percent of the cohort underwent primary cytoreduction and 22% underwent neoadjuvant chemotherapy/interval debulking surgery. OS was 2.6 years (range, 1.3–6.8 years). Seventy percent of patients received a platinum doublet as initial therapy, 47% of patients underwent an initial dose reduction, 46% required at least one transfusion, and 39% experienced at least one dose delay. When modeled as both continuous and binary variables, the need for chemotherapy delay and transfusion was significantly associated with a worsened OS (P = 0.02 and P b 0.05, respectively). The need to reduce chemotherapy dose either initially or throughout treatment did not affect OS (P = 0.14, P = 0.12). Multivariate analysis, including significant variables such as age, ASA class, and disease stage, demonstrated that any delay in chemotherapy remained significant as a predictor of OS (P = 0.029). Conclusions: In this study, elderly patients with ovarian cancer who underwent cytoreduction frequently required transfusion and needed dose delay. Multivariate analysis confirmed that dose delays, but not dose reductions, were independently associated with decreased OS.
doi:10.1016/j.ygyno.2014.03.099
Featured Poster Session IV: Cancer in the Elderly & Underserved Populations Monday, March 24, 2014 7:00 a.m.–8:00 a.m., Ballroom A Moderator: Trey Leath, MD, University of Alabama at Birmingham, Birmingham, AL
doi:10.1016/j.ygyno.2014.03.100
Abstracts / Gynecologic Oncology 133 (2014) 2–207
both. Significant reductions were noted between pre- and postintervention BMI (34.9 ± 8.7 vs 33.9 ± 8.4, P = 0.0005), body weight (92.3 ± 23.7 kg vs 90.1 ± 22.9 kg, P b 0.0001), and WC (102.7 ± 14.9 cm vs 98.3 ± 15.1 cm, P = 0.0006). A trend toward significance was noted between pre- and postintervention total WEL scores (93.8 ± 41.1 vs 115.1 ± 48.1, P = 0.08). There was a moderate positive correlation between total WEL scores and the amount of health care provider feedback and push notifications (r = +0.349, P = 0.382). Conclusions: These results indicate that a lifestyle intervention application is a feasible option by which to elicit short-term reductions of BMI and WC by 3% to 4%. Although these results parallel the recent SUCCEED (Survivors of Uterine Cancer Empowered by Exercise and healthy Diet) trial, it is notable that they were achieved without encumbering cost and barrier-access issues. We will continue to enroll patients until we achieve 50 completers. doi:10.1016/j.ygyno.2014.03.098
79 - Focused Plenary Metformin and the risk of endometrial cancer: A population-based cohort study E.M. Ko1,2, T. Sturmer2, J.L. Hong2, W. Camelo2, V.L. Bae-Jump3, M.J. Funk2. 1 University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA, 2 University of North Carolina Gillings School of Public Health, Chapel Hill, NC, USA, 3University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Objectives: Metformin may decrease the risk of developing cancer, but its role in gynecologic cancers is not yet clear. We sought to compare whether women who initiate treatment with metformin vs sulfonylureas had a lower risk of endometrial cancer. Methods: A retrospective cohort analysis was performed using Truven Health Analytics MarketScan® Databases from 2000 to 2011. We identified new users of metformin or sulfonylureas and estimated HR and 95% CI with Cox Proportional Hazards, using an as-treated analytic approach. Stabilized inverse probability of treatment weights (IPTW) were used to adjust for potential confounders. Crude and IPTW-adjusted survival curves were estimated using the Kaplan–Meier method. Results: Of 541,128 eligible women, 456,838 (84%) initiated metformin and 84,290 (16%) initiated sulfonylurea. Baseline covariates, including age, diabetes, polycystic ovarian syndrome, and endometrial hyperplasia, differed between metformin and sulfonylurea users. Over a median follow-up of 1.2 years (interquartile range [IQR] 0.4–2.3) and a total follow-up of 2,030,914 person-years, 729 women developed endometrial cancer. Metformin use appeared to reduce the risk of endometrial cancer in the unadjusted analysis (HR 0.81, 95% CI 0.67–0.97). However, after balancing all baseline covariates using IPTW, metformin did not decrease the risk of endometrial cancer (HR 1.09, 95% CI 0.88–1.35). Multiple subgroup analyses in diabetic patients and varying age groups revealed similar nonprotective findings. Conclusions: In this population-based cohort of more than 500,000 women, initiating antidiabetic therapy with metformin compared with sulfonylureas was not associated with the risk of developing endometrial cancer. Further studies may determine if metformin may help reduce endometrial cancer in other subsets of particularly high-risk women.
80 – Featured Poster Dose delay, but not dose reduction, in chemotherapy administration is associated with decreased survival in elderly women with ovarian cancer N. Joseph1,2, R.M. Clark1,2, M. Lee1, K. Kopecky2, D.S. Dizon1,2, W.B. Growdon1. 1Brigham and Women's Hospital, Boston, MA, USA, 2 Harvard University, Boston, MA, USA. Objectives: Elderly patients with ovarian cancer represent a vulnerable population that frequently demonstrates poor outcomes. The objective of this study was to characterize risk factors and treatment patterns in this population and how they relate to overall survival (OS). Methods: After obtaining institutional review board approval, we identified all patients N65 years with stages II–IV epithelial ovarian cancer who underwent cytoreduction at our institution between the years of 2003 and 2011. Relevant clinical variables were extracted and correlated with OS. Statistical analysis was performed using logistic regression, Kaplan–Meier curves, and multivariable Cox proportional hazard models. Results: A total of 184 patients were included in the analysis. The average age was 73 years and median ASA class was 2. Seventy-eight percent of the cohort underwent primary cytoreduction and 22% underwent neoadjuvant chemotherapy/interval debulking surgery. OS was 2.6 years (range, 1.3–6.8 years). Seventy percent of patients received a platinum doublet as initial therapy, 47% of patients underwent an initial dose reduction, 46% required at least one transfusion, and 39% experienced at least one dose delay. When modeled as both continuous and binary variables, the need for chemotherapy delay and transfusion was significantly associated with a worsened OS (P = 0.02 and P b 0.05, respectively). The need to reduce chemotherapy dose either initially or throughout treatment did not affect OS (P = 0.14, P = 0.12). Multivariate analysis, including significant variables such as age, ASA class, and disease stage, demonstrated that any delay in chemotherapy remained significant as a predictor of OS (P = 0.029). Conclusions: In this study, elderly patients with ovarian cancer who underwent cytoreduction frequently required transfusion and needed dose delay. Multivariate analysis confirmed that dose delays, but not dose reductions, were independently associated with decreased OS.
doi:10.1016/j.ygyno.2014.03.099
Featured Poster Session IV: Cancer in the Elderly & Underserved Populations Monday, March 24, 2014 7:00 a.m.–8:00 a.m., Ballroom A Moderator: Trey Leath, MD, University of Alabama at Birmingham, Birmingham, AL
doi:10.1016/j.ygyno.2014.03.100