Addressing the Link Between Neoadjuvant Chemo and Readmission Rates in Ovarian Cancer

Emma L. Barber, MD

Emma L. Barber, MD

Administering neoadjuvant chemotherapy to ovarian cancer patients who are likely to benefit from the treatment can not only result in decreased complication rates, but may also help comply with the push to decrease hospital readmission rates, says Emma L. Barber, MD.

Barber, a gynecologic oncology fellow at the University of North Carolina, discussed her research into neoadjuvant chemotherapy and its effect on hospital readmission rates during an interview withTargeted Oncologyat the 2017 Society of Gynecologic Oncology Annual Meeting.

TARGETED ONCOLOGY:Can you give an overview of your discussion on surgical readmission and survival in women with ovarian cancer?

Barber:

I’m very interested in how the overarching quality and push toward quality is effecting populations differently. There’s been this overarching push with the Affordable Care Act to basically decrease hospital readmissions. The thought is that if someone comes into your hospital and they have a problem, they go home and they come right back, you have not handled that problem appropriately, so there’s been a big push to decrease admissions. That argument sounds very simple and straight forward, but it becomes a little bit more complicated than that with ovarian cancer because there’s a difference between short-term morbidity—what happens to you in the 30 days following surgery—and what happens to you over a long period of time.

Specifically for ovarian cancer, aggressive surgery is associated with more complications, and resection to no gross residual disease is associated with improved long-term outcomes, but increased rates of complication. It’s an incentive that might be effecting our population differently.

I looked specifically at neoadjuvant chemotherapy, which is a technique that has been shown to decrease surgical morbidity. If you give the chemotherapy first, the surgery is not as complicated, so your complication rates go down, and nobody has looked at readmission rates yet, but what I’m presenting shows that those go down as well.

The point is that if this overarching system—hospital administrators and centers for Medicare and Medicaid services—are pushing us to decrease readmissions, are we going to change how we care for women with ovarian cancer, and is that the best thing for them? And that’s the question that our abstract is posing.

TARGETED ONCOLOGY:Are there any next steps planned?

Barber:

I think the next steps for this are to make sure that our patients are aware of this, that we advocate for this. This is a small community, and the policy makers that are thinking overall in the healthcare system aren’t focused on this small community where aggressive surgery is associated with improved outcomes, so I think we need to make that point to make sure that healthcare systems and providers aren’t pushed in a way that may not help patients in the long run.

TARGETED ONCOLOGY:What would you like community oncologists to take away from your presentation and ultimately bring back to their practices?

Barber:

I think 1 point is that the use of neoadjuvant chemotherapy will decrease your readmission rate, if that’s a high priority. It is a treatment that’s associated with decreased short-term morbidity, even in populations that are at a high risk for readmission. On an individual basis you have to decide if that’s the best thing for your patient long term. There may be patients for whom it is, and there may be others for whom it’s not. Making sure that we continue to advocate with an individualized approach for these women is important.

TARGETED ONCOLOGY:How can it be determined which patients will respond better to the use of neoadjuvant chemotherapy than others?

Barber:

We tend to think of neoadjuvant chemotherapy as reserved for people who are not going to do well with surgery, who are not going to be able to have a resection and no gross residual disease when the tumor is removed.

In European randomized trials, the 2 approaches are surgery first, followed by chemotherapy, or chemotherapy first, followed by surgery, which have been shown to be equivalent. But in some patients with stage IIIc disease, even in those trials with patients with a smaller burden of disease, upfront surgery improves their survival. Even in that population, surgery first is going to be associated with more short-term morbidity.

TARGETED ONCOLOGY:Speaking more generally, are there any ongoing clinical trials in the field of ovarian cancer that you’re particularly interested in?

Barber: