Compliance to treatment guidelines and survival in women undergoing interval debulking surgery for advanced epithelial ovarian cancer

Abstract

Background: One of the primary treatment strategies for advanced epithelial ovarian cancers includes neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and adjuvant chemotherapy. Compliance to treatment is important to possibly improve outcomes.Aim: To audit treatment compliance and its effect on overall survival (OS) and disease free survival (DFS) in women undergoing IDS.Methods and Results: Women diagnosed with advanced epithelial ovarian cancer undergoing IDS were included. Details of compliance to chemotherapy and surgery as per standard guidelines were assessed, and correlation with survival was studied.Reasons for protocol deviation at various levels were documented and analysed.A total of 182 patients were included. The total number of deviations was 134 with deviation at any level being 89 (48.9%) and at all levels 5%. Both patient-and treatment-related factors contributed towards deviation. Deviation or noncompliance towards treatment resulted in a significantly reduced 5-year OS (34.4% vs 58.2%; P = .001) compared with compliant patients, which retained its significance on multivariate analysis (P = .024) as well. Conclusion: Deviation from treatment guidelines resulted in a significantly lower 5year OS compared with those who remained treatment compliant. Both patient-and treatment-related factors contributed towards noncompliance and hence towards lower survival.