Survival Outcomes in Ovarian and Uterine Cancer Patients Receiving Neoadjuvant Chemotherapy: A Retrospective Comparison of Inpatient Versus Outpatient Settings

Abstract

Objectives: Chemotherapy administration has largely shifted from inpatient to outpatient settings, offering benefits like increased patient comfort, fewer hospitalizations, and reduced costs. However, inpatient care remains crucial for patients needing direct observation, intensive side effect management, or those with significant medical comorbidities. Despite clinicians using their judgment and available guidelines to determine the best treatment setting, there's a notable scarcity of literature on outcomes between these settings, especially within gynecologic oncology. This study aimed to evaluate the survival differences of patients with endometrial and ovarian cancer who received neoadjuvant chemotherapy (NACT) in either outpatient or inpatient settings.

Methods: We identified and reviewed charts for 146 endometrial or ovarian cancer patients treated with NACT at Montefiore Medical Center between 2010 and 2023. This cohort comprised 47 patients in the inpatient group and 99 in the outpatient group.

Results: Our findings indicated that the inpatient group had a higher mean ECOG performance status, received fewer chemotherapy cycles, and were less likely to undergo surgery. While initial analysis suggested poorer survival for the inpatient group (p = 0.019), this difference became statistically insignificant after controlling for various confounders.

Conclusions: Despite initial indications of poorer outcomes for inpatient NACT, this difference was not statistically significant once confounding factors were addressed. These results provide important reassurance that inpatient chemotherapy, when clinically indicated, does not lead to inferior oncologic outcomes. Further research is essential to better understand optimal chemotherapy delivery and to identify and address obstacles to patient care.