Trend of Chemo Before Surgery Bucks Standard of Care for Ovarian Cancer

June 4, 2014

Chemo after surgery for ovarian cancer is the standard of care, but new research discovers that many women, particularly older women, are undergoing chemo before surgery.

More women, particularly those 70 and older, are undergoing chemotherapy prior to surgery to remove ovarian cancer. But the trend is not tied to improved outcomes, nor is it recognized as a standard of care.

A review of about 58,000 medical records revealed the trend after noting that more than a quarter of women received chemotherapy prior to surgery in 2011, up from nearly 9% of cases in 1998. 

Pertinent Points

- Chemotherapy is increasingly being used prior to surgery to treat women with ovarian cancer, bucking the standard of care.

- An analysis of the trend indicated that women who receive chemotherapy prior to surgery are older, have other health complications, have more advanced disease, and are more likely to be on Medicare or Medicaid.

"What we do know is that patients in general are aging, and older patients are more likely to both have additional illnesses and receive neoadjuvant chemotherapy,” she said. “So it's possible this factor may help explain why more women are receiving neoadjuvant chemotherapy."

Given the age and health of the women most likely to receive neoadjuvant chemotherapy, Jain and her colleagues said it wasn’t surprising that the median survival rate did not outpace women whose treatment followed the standard of care of surgery prior to chemotherapy.

Even though survival wasn’t improved, the analysis did indicate that among women with stage 4 disease, those who had neoadjuvant chemotherapy had fewer complications after surgery and survived just as long as other stage 4 women.

The results of the research were presented at the annual meeting of the American Society of Clinical Oncology Researchers. The researchers also noted that more research is needed before specific recommendations can be made.

“It's a judgment call of the oncologist to decide if a patient is healthy enough to have surgery or not, and whether the gynecologic oncologist feels that they can remove all of the tumor during surgery" Jain said.

The analysis of the records, which were obtained through the National Cancer Database, also revealed that women insured through Medicaid or Medicare were more likely to receive chemotherapy prior to surgery, but that race and geography did not appear to play a role.