Impact of the Coronavirus Disease 2019 pandemic on neoadjuvant chemotherapy use in patients diagnosed with epithelial type ovarian cancer.

Autor:	Mukherjee A; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States., Shammas N; Obstetrics and Gynecology, Adventist Health White Memorial Medical Center, Los Angeles, CA, United States., Xu L; Data Reporting and Analytics, MedHealth Statistical Consulting Inc., Solon, OH, United States., Cannavale KL; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States., Gilfillan AD; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States., Szamreta EA; Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States., Monberg M; Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States., Hodeib M; Gynecology Oncology, Kaiser Permanente Southern California, Riverside, CA, United States., Chao CR; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2024 Mar 27; Vol. 14, pp. 1290719. Date of Electronic Publication: 2024 Mar 27 (Print Publication: 2024).
DOI:	10.3389/fonc.2024.1290719
Abstrakt:	Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic posed critical challenges in providing care to ovarian cancer (OC) patients, including delays in OC diagnosis and treatment initiation. To accommodate for delays in OC surgery, the Society of Gynecologic Oncology (SGO) recommended preferential use of neoadjuvant chemotherapy during the pandemic. The purpose of this study was to assess the association of the COVID-19 pandemic with neoadjuvant chemotherapy use in patients diagnosed with OC. Methods: This retrospective cohort study included patients diagnosed with stage II-IV ovarian cancer of epithelial subtype between 01/01/2017-06/30/2021 at Kaiser Permanente Southern California (KPSC), a large integrated healthcare system in the United States. Ovarian cancer patients diagnosed between 2017-2020 were identified from KPSC's Surveillance, Epidemiology, and End Results (SEER)-affiliated cancer registry. Patients diagnosed in 2021 were identified from the electronic medical records (EMR) using ICD-10 diagnosis codes, followed by medical chart review to validate diagnosis and extract information on histology and stage at diagnosis. March 4, 2020 was used as the cut-off to define pre-pandemic and pandemic periods. Patients diagnosed with COVID-19 between OC diagnosis and treatment completion were excluded. Data on neoadjuvant chemotherapy use were extracted from the cancer registry and EMR, supplemented by chart review. Modified Poisson regression was used to evaluate the association of the pandemic with neoadjuvant chemotherapy use. Results: Of 566 OC patients, 160 (28.3%) were diagnosed in the pandemic period. Patients diagnosed in the pandemic period were slightly younger (mean age 62.7 vs 64.9 years, p=0.07) and had a higher burden of Charlson comorbidities (p=0.05) than patients diagnosed in pre-pandemic period. No differences in time to treatment initiation were observed by pandemic periods. Neoadjuvant chemotherapy use was documented in 58.7% patients during the pandemic period compared to 47.3% in pre-pandemic period (p=0.01). After adjusting for covariates, patients diagnosed in the pandemic period were 29% more likely to receive neoadjuvant chemotherapy than patients diagnosed in pre-pandemic period [RR(95%CI): 1.29(1.12-1.49)]. Discussions: Ovarian cancer patients diagnosed in the COVID-19 pandemic were more likely to receive neoadjuvant chemotherapy than patients diagnosed before the pandemic. Future research on patient outcomes and trends in the post-pandemic period are warranted. Competing Interests: Author LX was employed by MedHealth Statistical Consulting Inc. Authors ES and MM are employees of Merck & Co, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. The authors declare that this study received funding from Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, and AstraZeneca UK Ltd. The funder was involved in the study design and interpretation of data. (Copyright © 2024 Mukherjee, Shammas, Xu, Cannavale, Gilfillan, Szamreta, Monberg, Hodeib and Chao.)
Databáze:	MEDLINE
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