Does palliative chemotherapy palliate? Evaluation of expectations, outcomes, and costs in women receiving chemotherapy for advanced ovarian cancer

Purpose: The value of palliative chemotherapy in women with refractory and recurrent ovarian cancer is difficult to quantify, and little is known abou t patient expectations from these treatments. We evaluated in the current p rospective study patient expectations, palliative outcomes of chemotherapy, and the inherent resource utilization in patients undergoing second- or th ird-line chemotherapy for recurrent or refractory advanced ovarian cancer. Methods: The European Organization for Research and Treatment of Cancer Qua lity-of-Life Questionnaire C30 (EORTC QLQ C30) and Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaires were used to assess palliat ive benefit and an in-house questionnaire was used to gauge patient expecta tions. The minimal clinically important difference (MCID) wets calculated b y asking women to make a global rating of change and correlating this to th e EORTC QLQ C30. Resource use was recorded and costs were calculated. Results: Twenty-seven patients were accrued. Objective response was documen ted on seven of 27. The median survival was 11 months. Sixty-five percent o f women expected that chemotherapy would make them live longer and 42% that if would cure them. After two cycles, quality-of-life (QL) improvement was seen particularly in global function (11 of 21) and emotional function (13 of 21) with EORTC QLQ C-30. improvement wets sustained for a median of 2 a nd 3 months, respectively, in these categories. The MCID was calculated to be 0.39 ana seven-point scale for physical function and 0.13 for global fun ction. The mean fetal cost per patient for the study period was Can $12,500 . Conclusion: patient expectations from these treatments are often unrealisti c. Although objective responses are low, active palliation with chemotherap y is associated with substantive improvement in patients' emotional functio n and global QL, with overall costs that seem relatively modest. J Clin Onc ol 19:1266-1274. (C) 2001 by American Society of Clinical Oncology.