Date of Award

Spring 4-24-2024

Embargo Period

4-24-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Health & Rehabilitation Science

Department

Health Sciences and Research

College

College of Health Professions

First Advisor

Kit Simpson

Second Advisor

Annie Simpson

Third Advisor

Thomas Curran

Abstract

Bevacizumab, a targeted VEGF inhibitor, is recommended for treatment of advanced ovarian cancer based on clinical trials demonstrating improved progression-free survival when added to standard chemotherapy. This study describes demographic, clinical and social factors, and outcomes associated with bevacizumab use among ovarian cancer patients in the US Medicare 5% sample. Kaplan-Meier curves and propensity score-weighted Cox proportional hazards models were used to estimate overall survival (OS) comparing bevacizumab to non-bevacizumab regimens. Of 3,760 patients with a principal diagnosis of ovarian cancer from 2016 to 2019, 1,508 had at least one observed line of chemotherapy; 457 had a second line following a treatment-free interval (TFI) ≥60 days, of whom 52% (N=237) received bevacizumab. Receipt of bevacizumab did not vary by dual eligibility for Medicaid (an indicator of poverty) or residing in a vulnerable community (measured by the social vulnerability index). Patients receiving bevacizumab were more likely to have metastatic disease and a TFI ≤180 days (an indication of platinum-resistant disease) at second-line treatment initiation. Bevacizumab was associated with a modest survival advantage and lower relative risk of death (hazard ratio=0.80, 95% confidence interval=0.66, 0.97) among patients who received bevacizumab within 30 days after second-line initiation, particularly those younger than age 75.

Rights

Copyright is held by the author. All rights reserved.

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