Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality

Abstract

Ovarian cancer is the deadliest gynecologic cancer. Receipt of treatment from a gynecologic oncologist is an evidence-based recommendation to reduce mortality from the disease. We examined knowledge and application of this evidence-based recommendation in primary care physicians as part of CDC gynecologic cancer awareness campaign efforts and discussed results in the context of CDC National Comprehensive Cancer Control Program (NCCCP). We analyzed primary care physician responses to questions about how often they refer patients diagnosed with ovarian cancer to gynecologic oncologists, and reasons for lack of referral. We also analyzed these physicians’ knowledge of tests to help determine whether a gynecologic oncologist is needed for a planned surgery. The survey response rate was 52.2%. A total of 84% of primary care physicians (87% of family/general practitioners, 81% of internists and obstetrician/gynecologists) said they always referred patients to gynecologic oncologists for treatment. Common reasons for not always referring were patient preference or lack of gynecologic oncologists in the practice area. A total of 23% of primary care physicians had heard of the OVA1 test, which helps to determine whether gynecologic oncologist referral is needed. Although referral rates reported here are high, it is not clear whether ovarian cancer patients are actually seeing gynecologic oncologists for care. The NCCCP is undertaking several efforts to assist with this, including education of the recommendation among women and providers and assistance with treatment summaries and patient navigation toward appropriate treatment. Expansion of these efforts to all populations may help improve adherence to recommendations and reduce ovarian cancer mortality.

Disparities in ovarian cancer survival in the United States (2001‐2009): Findings from the CONCORD‐2 study

“…The CDC's NCCCP operates in all 50 states, the District of Columbia, 7 tribal governments and organizations, and 7 territories and US‐associated Pacific Island jurisdictions to support the development and implementation of evidence‐based initiatives to prevent and control cancer . Recent studies have documented prior ovarian cancer activities of the NCCCP; nearly one‐half of programs are undertaking activities related to ovarian cancer, which largely center on education, primary prevention, and implementation of interventions to improve ovarian cancer survivors’ well being . Primary prevention activities include promoting smoking cessation and smoke‐free environments, because smoking is a risk factor for some types of ovarian cancer, as well as the promotion of breastfeeding among women who have the opportunity, which several studies have suggested reduces risk for epithelial ovarian cancer .…”

Patient and Provider Perspectives on Barriers to Accessing Gynecologic Oncologists for Ovarian Cancer Surgical Care

“…Behavior. 11,[24][25][26][27][28][29][30] While the Theory of Reasoned Action focuses on understanding attitudes, intentions, and beliefs as determinants of behaviors, the Theory of Planned Behavior accounts for factors beyond the interviewee's control that limit or facilitate one's behaviors and choices.…”

“…[3][4][5][6][7][8] Current National Comprehensive Cancer Network (NCCN) clinical guidelines and other national organizations recommend that all women with stage IB-IV ovarian cancer receive surgical care from a gynecologic oncologist. 3,[9][10][11][12][13] Despite the evidence of improved outcomes and NCCN recommendations, as many as 30% of women with ovarian cancer in the United States and nearly 15% of women in Iowa are not receiving surgical care from a gynecologic oncologist. 11,[14][15][16][17][18][19][20] Researchers have hypothesized this discrepancy between recommended and received care is due to the incidental diagnosis, discovery of cancer during non-cancer surgery and disagreement about standards of care.…”

“…3,[9][10][11][12][13] Despite the evidence of improved outcomes and NCCN recommendations, as many as 30% of women with ovarian cancer in the United States and nearly 15% of women in Iowa are not receiving surgical care from a gynecologic oncologist. 11,[14][15][16][17][18][19][20] Researchers have hypothesized this discrepancy between recommended and received care is due to the incidental diagnosis, discovery of cancer during non-cancer surgery and disagreement about standards of care. 21,22 Low referral rates may also be associated with receipt of care at a rural hospital or a low-volume hospital, and lower patient income or a lack of insurance.…”

“…3,7,22,23 Finally, others have hypothesized that geographic disparities and distance impact access to care from a gynecologic oncologist. 11 Assessing patient and provider barriers and attitudes in receiving care from a gynecologic oncologist may help develop evidence-based interventions to increase adherence to guideline-recommended surgical care within the state of Iowa. We aimed at assessing barriers and attitudes regarding referral to specialty care from both the patient and provider perspective.…”