Neoadjuvant vs Primary Surgery: A NCDB Study with Alex Melamed

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Alex Melamed to discuss neoadjuvant versus primary surgery. Alex Melamed is a gynecologist oncologist and a health services researcher at Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Columbia Irving Medical Center. Highlights: - The emergence of evidence supporting non-inferiority of neoadjuvant chemotherapy (NACT) compared with primary surgery for advance ovarian cancer led to increased utilization of NACT. - However, while some cancer programs in the U.S. doubled their use of NACT, others continued to use this approach infrequently. - The differential adoption of NACT by cancer programs can be viewed, and analyzed, as a natural experiment using a difference-in-differences study design.

- Compared with programs that continued to use NACT infrequently, high users of NACT had similar improvements in median survival, with greater reductions in 6-month and 12-month mortality.