Impact of Shifting From Office- to Hospital-Based Treatment Facilities on the Administration of Intraperitoneal Chemotherapy for Ovarian Cancer

Introduction: Cancer chemotherapy in the United States has been delivered mostly in an office-based setting since the late 1980s. However, in the past 5 years, more patients have been treated in hospitals as a result of reimbursement changes. Intraperitoneal (IP) chemotherapy for ovarian cancer has been similarly affected. This report examines changes in care of women treated with IP chemotherapy in an office- versus hospital-based setting.

Methods: Over 10 years, 140 women with ovarian cancer were identified as candidates for IP chemotherapy. Of these patients, 92 were treated in an oncology-dedicated infusion center in the office of a physicians’ group; 48 were treated in a local hospital. Location was determined based on insurance coverage and reimbursement. Data collected included demographics, number of treatment cycles completed, length of each treatment, and adverse events.

Results: The age and ethnicity of patients treated in the office versus hospital were similar. All six doses of intravenous IP chemotherapy were completed by 73 (79%) of 92 patients treated in the office versus 23 (48%) of 48 patients treated in the hospital (P < .001). The time of each infusion was longer in the hospital-versus office-based setting (P < .001). There were more adverse events associated with treatment in the hospital.

Conclusion: IP chemotherapy is associated with worse outcomes in the hospital- compared with office-based setting. The reason seems to involve a relative lack of resources directed specifically to chemotherapy administration. If current reimbursement trends continue, this could result in decreased survival for women with ovarian cancer.

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