benefit of chemotherapy for subsets of patients with early-stage ovarian
cancer has subsequently been confirmed in several trials [3,10,11].
Although there is general consensus about the use of adjuvant chemotherapy
in high-risk early-stage patients, there is a debate about
the optimal duration of chemotherapy. A randomized GOG trial comparing
three versus six cycles of platinum and taxane-based chemotherapy
showed no survival benefit for extended chemotherapy although
this strategy was accompanied by increased toxicity [7]. While the
trial concluded that the optimal treatment for these patients is three cycles
of chemotherapy, methodologic concerns have led to continued debate
about the optimal duration of chemotherapy [1,9]. While the risk of
recurrence for stage I patients is lower, when patients do recur, treatment
is palliative [1]. Given these findings, appropriate initial management
of early-stage ovarian cancer is paramount.
Given the controversy surrounding the management of early-stage
ovarian cancer, we performed a population-based analysis to examine
the quality of care and outcomes for women with early-stage ovarian
cancer. Specifically, we explored the adherence to guideline-based recommendations
for the administration of adjuvant chemotherapy and
analyzed the influence of the duration of chemotherapy on survival
for early-stage, high-risk patients.