Palliative therapy in advanced ovarian cancer: balancing patient expectations, quality of life and cost.

The goals of chemotherapy for recurrent/refractory ovarian cancer are the palliation of disease-related symptoms, and improvement of quality and quantity of life. Previous studies of palliative therapy in advanced ovarian cancer have focused on surrogate measures of patient benefit rather than evaluating palliative end-points such as quality of life and clinical benefit. The impact of palliative chemotherapy on survival, quality of life and cost in advanced ovarian cancer are unknown as there have been no studies comparing palliative treatment with best supportive care. Although there is insufficient information from existing studies to determine whether palliative therapy in advanced ovarian cancer is cost-effective, there is some evidence to suggest that chemotherapy has a role in palliation of symptoms with an apparent improvement in quality of life. We relate the results of two studies. (i) A prospective study evaluating the cost of second/third-line chemotherapy as well as its effectiveness, which found the mean total cost per patient for the study period (one line of chemotherapy) was Canadian $12500. In addition, half of patients seemed to derive some palliative benefit and a quarter of patients had an objective response in their disease. (ii) A retrospective study evaluating all costs from the initiation of palliative chemotherapy until death which demonstrated a cost of Canadian $53000 per patient. Our studies demonstrate that patient expectations of palliative therapy in ovarian cancer are high and patients are willing to put up with significant toxicity for modest benefit. Although palliative therapy may be associated with high costs, even modest prolongation of survival can render such treatment cost-effective. The major cost saving associated with palliative therapy is from the reduced need for hospitalization towards the end of life. Future studies in recurrent/refractory ovarian cancer should focus on palliative end-points and include a comparison with best supportive care.