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Prometrium vs generic progesterone (Holland et al., 2012), it is apparent that there were distinct treatment effects that could be investigated using the current data collection approach used for our secondary outcomes outcomes. The number of active treatments per year at month 28 was more frequent in those that experienced a favourable treatment outcome at month 24 than in those that did not. This could suggest that it was easier for women to improve their hormone treatment in a timely manner. This finding is consistent with prior research which found a dose-dependent increased efficacy of hormones in the early to middle-stage of ovarian cancer treatment (Bertone et al., 2004; Kontisz 2012). However, the positive effect of a first-line hormonal treatment was not sustained for long term follow-up after the initial treatment (Kontisz et al., 2011). Although the time to treatment completion in our study has been extended to over nine years, women were exposed to both hormonal therapies by month 11 and received treatment for an average of 8.5 years, more than 9 years after the initial treatment. In long-term follow-up of the Dutch EORTC cohort, treatment failure was more common in women where the hormone treatment had a half-life of less than 8 months (Niet et al., 2012). This suggests that it may be useful to provide more frequent treatments women with long-term ovarian cancer to improve the outcome of treatment, although this was rarely performed at present. Although the current results show an increase in the number of treatments taken up or used during the study following primary treatment, this was not the case for all women taking up a second hormone therapy. number of studies were done using secondary outcomes which do not provide the same information as primary outcome measures on ovarian cancer progression. For example, in our study we were able to evaluate the effect of second hormone therapy on clinical outcomes over the long-term (more than 3 years) and over the course of a single treatment, but these did not compare well to a single primary outcome measure (primary in Kontisz et al. 2016). Furthermore, generic prometrium results can vary with the types of hormone therapy employed, in particular the effects of non-steroidal anti-inflammatory drugs, oestrogens and growth factors. To allow greater comparison of prometrium 200 mg cost treatment effects with current evidence, a more comprehensive dataset with additional measurements may be necessary. The present study included women with hormone-treated early-stage cancers that were still undergoing treatment or chemotherapy. Current experience suggests that patients with hormone-treated ovarian cancer do have an improved outcome when receiving a second treatment, but to determine whether further studies using data from both non-cancer patients and with hormone-treated early-stage cancers are warranted, it may be fruitful to do more research with this higher subgroup. The present study also investigated long- term effect of hormone therapy in relation to a long-term follow-up, but with greater detail of information than was available in the primary analysis. aim of this analysis was to compare the long-term outcome after treatment and a long-term follow- up. These factors could potentially represent non-inferiority, or possibly even superiority, of the results using current study methodology among women with non-cancer-induced hormone-treated early-stage cancers. However this will require confirmation in longer-term follow-up.

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