Question
What is the advantage in treating women with advanced epithelial ovarian cancer using neoadjuvant chemotherapy (NACT) before cytoreductive surgery as compared with conventional treatment using adjuvant chemotherapy after cytoreductive surgery?
Relevance to nursing care
Epithelial ovarian cancer is the most common form of ovarian cancer and the seventh most common cancer affecting women under the age of 65 years worldwide. Treatment options for advanced epithelial ovarian cancer are either NACT before surgery or adjuvant chemotherapy after surgery. Therefore, oncology nurses are in a vital position to advise and support patients when making decisions on treatment options.
Study characteristics
This review1 included one randomised controlled trial (RCT) containing 670 women. The women were diagnosed with advanced epithelial ovarian cancer (Federation of International Gynaecologists and Obstetricians stage IIIc/IV). The intervention of interest was primary debulking surgery (PDS) followed by platinum-based chemotherapy, compared with platinum-based NACT followed by debulking surgery. The outcome measures included overall survival (OS), progression free survival (PFS), quality of life, surgical morbidity and mortality, and toxicity and optimal debulking of the tumour. This trial was at low risk of bias as randomisation and allocation concealment were performed centrally; all pre-specified outcomes were reported, and there was minimal loss to follow-up.
Meta-analyses were not possible due to only one study meeting inclusion requirements. Results for this RCT indicated there was no significant difference in OS or PFS between the NACT and PDS groups. However, there were significantly higher surgically related serious adverse effects in the PDS group; haemorrhage (relative risk (RR) 0.50; 95% confidence intervals (CIs) 0.25-0.99); venous thromboembolism (RR 0.06; 95% CI 0-0.98) and infection (RR 0.19; 95% CI 0.07-0.50). Quality of life was reported to be similar in both groups.
Implications for nursing care
As the review indicated that surgically related morbidity was significantly higher in the PDS group, nurses should pre-empt and educate patients on the options for chemotherapy prior to surgery and the potential benefits, in terms of reduced surgical morbidity, in those patients with advanced disease, thought more suitable for NACT.
Implications for research
There are currently three ongoing RCTs comparing the NACT and PDS for patients with advanced ovarian epithelial cancer. The outcome of the trials may change the state of current evidence that will be available in due course.
A member of the Cochrane Nursing Care Field (CNCF)
Reference