Centralisation of services for gynaecological cancer

Abstract

Background Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. Objectives To assess the effectiveness of centralisation of care for patients with gynaecological cancer. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies. Selection criteria We included randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies that examined centralisation of services for gynaecological cancer, and used multivariable analysis to adjust for baseline case mix. Data collection and analysis Three review authors independently extracted data, and two assessed risk of bias. Where possible, we synthesised the data on survival in a meta-analysis. Main results Five studies met our inclusion criteria; all were retrospective observational studies and therefore at high risk of bias. Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. Adverse event data were not reported in any of the studies. Authors’ conclusions We found low quality, but consistent evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere. The evidence was stronger for ovarian cancer than for other gynaecological cancers. Further studies of survival are needed, with more robust designs than retrospective observational studies. Research should also assess the quality of life associated with centralisation of gynaecological cancer care. Most of the available evidence addresses ovarian cancer in developed countries; future studies should be extended to other gynaecological cancers within different healthcare systems.

Prognostic Factors Affecting Survival in Patients with Ovarian Cancer: A 5-Year Experience in an University Hospital.

“…5 An elevated CA125 was not determinant factors of OS in our study (p> 0.05) in our study. Similar to the study of Whoo et al 24 CA125 level was not influence on OS for OC. However we found that presence of recurrence had significant effect on survival in OC (p> 0.05).…”

“…Most patients diagnosed with OC, survival is theorized to be 100%, who are still alive after 5-years, are presumably living with the disease rather than living disease-free. 5 Our analysis demonstrated that the DFS was 18.3 months (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The Surveillance, Epidemiology and End Results-SEER database from 1995 to 2007 with epithelial OC who were actively followed-up and age 20 years or older were included for analyzing OS in the United States (40.692 patients) and OS was 65%, 44%, and 36% at 2, 5, and 10 years, respectively.…”

“…In our study, the patients are referred to the study hospital because they do not have a high-quality healthcare setting in the periphery. In our study, patients who traveled less than 50 miles for their cancer care 24 in 2012 identified five studies (total 62.987 women with gynecological cancer), and concluded that women with advanced OC may have improved outcomes if treated in specialist centers (in a twofold). In the light of this information, these results would be important for future studies to assess the survival associated with centralization of this cancer care.…”

“…18,[22][23][24][25][26] We scrutinized the analyzing related to various prognostic factors for OC. In the present study younger women, those diagnosed before the age of 40, had significantly better survival after five years than women diagnosed at older ages (p< 0.05).…”

Economic evaluations on centralisation of specialised healthcare services: a systematic review of methods

“…Lord Darzi's 2007 report 1 recommended the reorganisation of London stroke and major trauma services into specialised centralised higher volume units catering for large populations with high-tech facilities and senior medical continuity. A number of studies [2][3][4][5][6][7][8][9] suggest that reconfiguring healthcare services into fewer consolidated units will lead to increase in high-quality care and better patient outcomes. Cost savings arguably resulting from the economies of scale is also one of the driving forces behind centralisation of healthcare services.…”