Impact of Provider Imaging Practices on Survival Outcomes in Advanced Ovarian Cancer

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  • 1 Department of Medicine, and
  • 2 Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York.
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Background: This study sought to describe how high- versus low-frequency surveillance imaging practices among providers at Memorial Sloan Kettering Cancer Center (MSKCC) impact overall survival (OS) and time to recurrence of patients with advanced epithelial ovarian cancer in first remission. Methods: The study cohort included patients with stage II–IV high-grade epithelial ovarian cancer diagnosed in January 2001 through January 2017 who experienced recurrence after initial platinum-based chemotherapy. To determine usual imaging practices for providers at MSKCC, median frequency of CT or MRI of the abdomen/pelvis was calculated among patients with a long-term remission (defined as at least 1 year) treated by each provider. Cox proportional hazards models were used to examine differences in OS and time to recurrence among patients treated by providers with high versus low imaging frequency practices, with additional subgroup analysis among patients with elevated CA-125 levels >35 U/mL at diagnosis. Chi-square tests were used to examine differences in the proportion of patients who enrolled in clinical trials or underwent secondary cytoreductive surgery (SCS) by imaging frequency. Results: A total of 543 patients were treated by providers with high imaging frequency (>1 scan every 12 months) and 141 were treated by providers with low imaging frequency (≤1 scan every 12 months). Time to recurrence was shorter among patients treated by providers with high versus low imaging frequency (18.0 vs 19.2 months; hazard ratio, 1.33; P=.003). Results were similar when restricted to patients with elevated CA-125 levels at diagnosis. There was no significant difference in OS, clinical trial enrollment, or SCS by imaging practice. Conclusions: Within the limitations of this retrospective analysis, patients with advanced ovarian cancer treated by high-frequency-imaging providers had earlier detection of recurrence. Future analyses in a larger population are warranted to elucidate the risks versus benefits of surveillance imaging.

Submitted June 21, 2019; accepted for publication October 29, 2019.

Author contributions: Study concept: Green, Korenstein, Aghajanian, O’Cearbhaill. Methodology: Green, Korenstein, Curry, O’Cearbhaill. Data curation: Green, Barrow. Investigation: Green, Barrow. Formal analysis: Curry. Writing (original draft): Green. Writing (review and editing): Green, Korenstein, Aghajanian, Curry, O’Cearbhaill.

Disclosures: Dr. Korenstein has disclosed that her spouse is a scientific advisor for Vedanta Biosciences and is a consultant for Takeda. Dr. Aghajanian has disclosed that she has received consultant fees from Tesaro, Immunogen, Clovis, Mateon Therapeutics, Eisai/Merck, Mersana Therapeutics, and Roche, and that she receives grant/research support from Clovis, Genentech, AbbVie, and AstraZeneca. Dr. O’Cearbhaill has disclosed that she has received consultant fees from Tesaro/GlaxoSmithKline. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

Correspondence: Angela K. Green, MD, MSc, Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017. Email: greena@mskcc.org

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