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EPV293/#425 Effect on overall survival of cancer program–level variation in the use of neoadjuvant chemotherapy for advanced ovarian cancer: a difference-in-differences study
  1. A Melamed1,
  2. JA Rauh-Hain2,
  3. A Gockley1,
  4. R Nitecki2,
  5. P Ramirez3,
  6. D Hershman4,
  7. N Keating5 and
  8. J Wright1
  1. 1Columbia University College of Physicians and Surgeons, Gynecologic Oncology, New York City, USA
  2. 2University of Texas MD anderson Cancer Center, Gynecologic Oncology, Houston, USA
  3. 3University of Texas MD anderson Cancer Center, Gynecologic Oncology and Reproductive Medicine, Houston, USA
  4. 4Herbert Irving Comprehensive Cancer Center, Oncology, New York City, USA
  5. 5Harvard Medical School, Health Policy, Boston, USA


Objectives To evaluate the effect of cancer program–level variations in use of neoadjuvant chemotherapy (NACT) on overall survival among patients with advanced ovarian cancer.

Methods We included women with advanced-stage epithelial ovarian cancer treated 2004–2015 in Commission on Cancer–accredited cancer programs that began administering NACT liberally or continued to restrict its use after the publication of a randomized trial in 2010. We used flexible parametric survival models to perform a difference-in-differences analysis evaluating the effect of liberal NACT administration on case-mix–standardized median overall survival and 1-year mortality rates.

Results We identified 19,562 patients treated in 332 cancer programs that increased use of NACT from 21.7% in 2004–2009 to 42.2% in 2010–2015 and 19,737 patients treated in 332 programs that marginally increased use of NACT (20.1% to 22.5%) over the same period. Standardized median overall survival improved by similar magnitudes in programs with liberal (from 31.6 to 37.9 months; 6.3-month difference; 95% CI, 4.2–8.3) and restrictive (from 31.4 to 36.8 months; 5.4-month difference, 95% CI, 3.5–7.3) use of NACT after 2010 (difference-in-differences, 0.9 months; 95% CI, −1.9 to 3.7). One-year mortality declined more in programs with liberal (from 25.6% to 19.3%; risk difference, −5.2%; 95% CI, −6.4 to −4.1) than with restrictive (from 24.9% to 21.8%; risk difference, −3.2%, 95% CI, −4.3 to −2.0) use of NACT (difference-in-differences, −2.1%; 95% CI, −3.7 to −0.5).

Conclusions Compared with cancer programs that administered NACT restrictively, those that administered it liberally achieved similar improvements in median overall survival and larger declines in short-term mortality.

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