Comparison of patient reported symptom burden on an enhanced recovery after surgery (ERAS) care pathway in patients with ovarian cancer undergoing primary vs. interval tumor reductive surgery

• Published in: Gynecologic oncology 2019-03, Vol.152 (3), p.501-508
• Main Authors: Meyer, Larissa A., Shi, Qiuling, Lasala, Javier, Iniesta, Maria D., Lin, Huei Kai, Nick, Alpa M., Williams, Loretta, Sun, Charlotte, Wang, Xin Shelley, Lu, Karen H., Ramirez, Pedro T.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Cytoreduction Surgical Procedures - methods; Cytoreductive surgery; Enhanced recovery after surgery; Female; Gynecologic Surgical Procedures - methods; Humans; Middle Aged; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Ovarian Cancer; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - surgery; Patient Reported Outcome Measures; Patient reported outcomes; Perioperative Care - methods; Surgical complexity; Tumor Burden; Young Adult
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2018.10.044

To compare symptom burden and functional recovery in women undergoing primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy (NACT) and interval cytoreductive surgery (ICS) within an enhanced recovery after surgery program (ERAS). Symptom burden was measured using the MD Anderson Symptom Inventory-Ovarian Cancer, a 27-item validated tool that was administered preoperatively, daily while hospitalized, and weekly for 8 weeks after hospital discharge. Mixed-effect modeling was performed. 196 patients (71 PCS, 125 ICS) participated. Patients in the PCS group were younger, median age of 59 vs. 63 in ICS group. Median length of stay was 4 days for PCS and 3 days for ICS group. PCS pts had a significantly higher median surgical complexity score (4 vs. 2, p = 0.002), and longer median surgical time (257 min vs. 220 min, p = 0.03). While patients undergoing PCS had significantly different symptom burden profiles prior to surgery compared to those undergoing ICS, there were no significant differences in symptoms in the immediate in-hospital and extended post-hospital discharge period. Irrespective of the timing of surgery in relation to chemotherapy, patients undergoing intermediate or high complexity surgery had more nausea, fatigue, and higher total interference scores compared to patients undergoing low complexity surgery. Within a center with a standardized, systematic method for patient selection for PCS and a standardized ERAS care pathway, there were not significant differences in surgery-related symptoms related to recovery between patients undergoing PCS or ICS. However, patient-reported symptom burden and symptom interference did meaningfully differentiate based on surgical complexity score. •Higher surgical complexity increases patient-reported interference from symptoms after ovarian cancer cytoreductive surgery.•Patients report higher baseline symptom burden prior to primary cytoreductive surgery compared to interval surgery.•Patients undergoing primary and interval cytoreductive surgery on ERAS pathways report similar pain levels after surgery.