The impact of comorbidity and guideline-concordant care on survival in ovarian cancer patients: a retrospective cohort study

Objective : To examine the impact of comorbidity on overall survival in ovarian cancer patients and determine whether guideline-concordant care (GCC) mitigates the adverse effects of comorbidity. Design : Retrospective cohort study. Setting : United States. Population : Ovarian cancer patients in the National Cancer Database (2004-2021). Methods : Patients with comorbidities were identified using the Charlson-Deyo Comorbidity index (0, 1, and ≥2) and a GCC metric was developed with patients classified as receiving concordant care if they received all eligible treatments, and discordant care otherwise. We generated Kaplan-Meier curves and Cox proportional hazards models to examine the association between comorbidity, GCC, and overall survival. Multiplicative and additive interactions were examined between comorbidity and GCC. Results : We identified 165,944 ovarian cancer patients. Overall survival decreased with increasing comorbidity score (p