Introduction Fragmentation of healthcare results when cancer care are provided at different institutions due to health insurance payer restrictions. The impact of this is studied on survival of ovarian cancer. The objective to examine the impact of fragmented healthcare on progression free survival(PFS).

Methods Patients with stage IIIC high-grade ovarian cancer analysed betweem 2011–2018. Patients who had a delay in chemo-initiation ( > 28 days following surgery) due to fragmentation of healthcare analyzed as cohort-1, compared to the patients who did not have any delay as cohort-2.We included patients’ surgical, tumor, perioperative, surgical, chemotherapy data to control for factors affecting chemo-initiation and PFS. Descriptive statistics and multivariate analyses were performed. The primary outcome was a Progression free survival attributable to fragmented healthcare.

Results Total of 491 ovarian cancer identified. There was 178/284 (67%) patients who had a delay in chemo-initiation. Cohort-1 (n=128) included patients who experienced a delay in chemo-initiation due to fragmentation of healthcare, cohort-2 (n=106) who did not have a delay. Both cohorts were ballanced. Multivariable-adjusted analysis showed that delay of chemo-initiation due to fragmented healthcare in cohort-1 was associated with shorter PFS compared to cohort-2 (18.1 months vs. 22.1 months; p<0.01); odds ratio [OR] 0.32 (0.23–0.68). Other factors contributing to shorter PFS included age OR 0.52 ( 0.32–0.78); stage OR 0.72 ( 0.52–0.87); grade OR 0.76 (0.53–0.99); and suboptimal cytoreduction OR 0.42 ( 0.25–0.67).

Conclusion/Implications Patients with advanced ovarian cancer who had a delay in chemo-initiation due to fragmented healthcare, had a shorter progression-free interval after controlling for all other relevant factors.