Effect of Surgeon Specialty on Processes of Care and Outcomes for Ovarian Cancer Patients

Earle, Craig C.; Schrag, Deborah; Neville, Bridget A.; Yabroff, K. Robin; Topor, Marie; Fahey, Angela; Trimble, Edward L.; Bodurka, Diane C.; Bristow, Robert E.; Carney, Michael E.; Warren, Joan L.

doi:10.1093/jnci/djj019

Cited by 381 publications

(231 citation statements)

References 22 publications

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“…8,9,[14][15][16][17][18] Despite these observations, the proportion of women with newly diagnosed ovarian cancer initially treated by gynecologic oncologists remains below 50% in the United States. 8,10,11 Although the available data is extremely limited, the factors affecting utilization of gynecologic oncology resources at the time of suspected ovarian cancer diagnosis appear to be multifactorial. Muntz and coworkers 19 reported that health maintenance organization physicians were 3 to 4 times less likely to refer patients with complex gynecologic oncology problems after soliciting a curbside consultation compared with private-practice colleagues.…”

Section: Commentmentioning

confidence: 99%

“…7 Although multiple population-based studies have documented that fewer than 50% of ovarian cancer patients in the United States are referred to gynecologic oncologists for surgery, there is surprisingly little data examining the preceding triage phase of the clinical care continuumereferral patterns of women diagnosed with an adnexal mass without a known diagnosis of ovarian cancer. [8][9][10][11] The objective of the current study was to determine the projected impact on referral patterns of patients undergoing surgery for an adnexal mass after initial evaluation by a nongynecologic oncologist using the MIA, CA125, modified-American College of Obstetricians and Gynecologists (ACOG) referral guidelines, and clinical assessment using the combined datasets of 2 previously reported clinical trials of the MIA.…”

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confidence: 99%

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Impact of a multivariate index assay on referral patterns for surgical management of an adnexal mass

Bristow

Hodeib

Smith³

et al. 2013

American Journal of Obstetrics and Gynecology

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OBJECTIVE:To determine the impact on referral patterns of using a Multivariate Index Assay, CA125, modified-American College of Obstetricians and Gynecologists referral guidelines, and clinical assessment among patients undergoing surgery for an adnexal mass after initial evaluation by nongynecologic oncologists.STUDY DESIGN: Overall, 770 patients were enrolled by nongynecologic oncologists from 2 related, multiinstitutional, prospective trials and analyzed retrospectively. All patients had preoperative imaging and biomarker analysis. The subset of patients enrolled by nongynecologic oncologists was analyzed to determine the projected referral patterns and sensitivity for malignancy based on multivariate index assay (MIA), CA125, modified-American College of Obstetricians and Gynecologists (ACOG) guidelines, and clinical assessment compared with actual practice. RESULTS:The prevalence of malignancy was 21.3% (n ¼ 164 MIA demonstrated statistically significant higher sensitivity (P < .0001) and lower specificity (P < .0001) for detecting malignancy compared with clinical assessment, CA125, and modified-ACOG guidelines. CONCLUSION:In this study population, use of MIA as a risk stratification test was associated with referral patterns by nongynecologic oncologists comparable to actual clinical practice and higher sensitivity for malignancy than other adnexal mass triage algorithms.

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Section: Commentmentioning

confidence: 99%

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confidence: 99%

Impact of a multivariate index assay on referral patterns for surgical management of an adnexal mass

Bristow

Hodeib

Smith³

et al. 2013

American Journal of Obstetrics and Gynecology

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“…[1][2][3][4] Hence, accurate methods to preoperatively characterize the nature of an ovarian tumor are pivotal. In 2008 the International Ovarian Tumor Analysis (IOTA) group described the Simple Rules.…”

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confidence: 99%

Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group

Timmerman

Calster

Testa

et al. 2016

American Journal of Obstetrics and Gynecology

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“…Multiple authors have reported five-year survival rates between 40 and 50% for patients with microscopic residual disease [1,6]. The rate of complete cytoreduction and associated survival has been shown to be both surgeon and institution dependent [7,8]. The radicality of procedures necessary to obtain this state of residuum does not appear to influence outcomes [1,5,9].…”

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confidence: 99%

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

Dowdy

Loewen

Aletti

et al. 2008

Gynecologic Oncology

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Objective-To describe the technique of diaphragmatic peritonectomy (DP) for ovarian cancer cytoreduction and to assess associated morbidity.Methods-Retrospective review yielded 56 patients who underwent DP as part of a cytoreductive procedure for primary or recurrent ovarian cancer between 1988 and 2004. Patients who underwent diaphragmatic resection, removal of diaphragmatic implants with CUSA, cautery, curette, or finger fracture, and patients with pseudomyxoma were excluded from analysis.Results-DP was performed as a component of primary or secondary cytoreduction in 37 (66%) and 19 (34%) patients, respectively. Extended procedures including bowel resection, hepatic resection, splenectomy, or radical hysterectomy were performed with DP in 47 patients (82%). Resection of all disease > 1 cm was achieved in 95% (microscopic residuum in 43%). For those undergoing primary cytoreduction, median survival was 59 months and 5-year survival was 49% with median follow-up of 34 months. When performed for recurrent ovarian carcinoma, 5-year survival was 16% and median survival was 23 months. No intra-operative complications could be specifically attributed to DP. Post-operative complications included a 30% rate of pleural effusion which was associated with entry into the pleural space during DP (p<0.0001); thoracentesis was required in 12.5%.Conclusions-Diaphragmatic metastases are a common obstacle to optimal cytoreduction for patients with ovarian cancer. When necessary, utilizing DP in concert with other extended procedures to obtain maximal cytoreduction is associated with excellent survival. It should be recognized that DP is associated with an increased incidence of post-operative pleural effusion, particularly when the pleural space is entered.

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Effect of Surgeon Specialty on Processes of Care and Outcomes for Ovarian Cancer Patients

Abstract: Ovarian cancer patients treated by gynecologic oncologists had marginally better outcomes than those treated by general gynecologists and clearly superior outcomes compared with patients treated by general surgeons.

Cited by 381 publications

References 22 publications

Impact of a multivariate index assay on referral patterns for surgical management of an adnexal mass

Impact of a multivariate index assay on referral patterns for surgical management of an adnexal mass

Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group

Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma

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