Occurrence and timing of advanced care discussions in recurrent ovarian cancer patients participating in clinical trials remain to be optimized

Objectives: In women with recurrent ovarian cancer (OC), advanced care planning (ACP) such as advanced directives (AD), code status, and timely hospice referral should be addressed. In a high-volume, clinical trial focused cancer center, treatment with novel potentially life-prolonging therapies may alter timing of discussions. Our study compares patterns of ACP between trial and non-trial recurrent OC patients. Methods: All patients ≥18 years who were treated at a single institution for the diagnosis of OC during the year of 2015 and had ever recurred were reviewed. Patients who ever (n=84) versus never (n=41) participated in a therapeutic clinical trial (CT) were compared. Chi-square or Fisher's exact tests and 2 sided t-tests or Wilcoxon Rank-Sum tests compared demographic data and ACP variables of interest using an α = 0.05. Multivariable logistic regression estimated adjusted odds ratios (aOR) adjusted by CT participation, age, and Charlson comorbidity index. Results: A total of 125 patients were identified, and 84 (67%) participated in CTs. Cohorts were similar in age, BMI, insurance status, and histopathologic characteristics. Median time to follow up after first recurrence was 856 days in trial patients vs 308 days in non-trial patients (p Download : Download high-res image (331KB) Download : Download full-size image Conclusions: The time between the recurrence and code status discussions was significantly longer in CT participants, and ACP discussions occurred typically during or after a trial. ACP occurred more frequently when patients were referred to palliative or supportive care referral, independent of participation in either late phase or phase 1 CT. Prioritizing ACP and supportive care referral, especially in CT participants, may improve these rates and optimize end of life care.