What changes in the organisation of cancer services will improve the outcome for women with ovarian cancer?

Woodman, Ciarán; Baghdady, Ashraf; Collins, Stuart; Clyma, Julie-Anne

doi:10.1111/j.1471-0528.1997.tb11032.x

Cited by 57 publications

(34 citation statements)

References 8 publications

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“…[6][7][8]10,[39][40][41][42][43][44] Recently, attention has focused on the potential for improved healthcare outcomes associated with concentration of cancer services in high-volume or expert centers. 45 A number of population-based studies have demonstrated conclusively that the surgical expertise and multidisciplinary care provided to patients with ovarian cancer at high-volume or expert centers are associated with superior survival outcomes compared with low-volume centers.…”

Section: Discussionmentioning

confidence: 99%

Centralization of care for patients with advanced‐stage ovarian cancer

Bristow

Santillan

Díaz-Montes

et al. 2007

Cancer

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BACKGROUND. The objective of this study was to evaluate the cost‐effectiveness of centralized referral of patients with advanced‐stage epithelial ovarian cancer who underwent primary cytoreductive surgery and adjuvant chemotherapy. METHODS. A decision‐analysis model was used to compare 2 referral strategies for patients with advanced‐stage ovarian cancer: 1) referral to an expert center, with a rate of optimal primary cytoreduction of 75% and utilization of combined intraperitoneal and intravenous adjuvant chemotherapy, and 2) referral to a less experienced center, with a rate of optimal primary cytoreduction of 25% and adjuvant treatment that consisted predominantly of intravenous chemotherapy alone. The cost‐effectiveness of each strategy was evaluated from the perspective of society. RESULTS. A cost‐effectiveness analysis revealed that the strategy of expert center referral had an overall cost per patient of $50,652 and had an effectiveness of 5.12 quality‐adjusted life years (QALYs). The strategy of referral to a less experienced center carried an overall cost of $39,957 and had an effectiveness of 2.33 QALYs. The expert center strategy was associated with an additional 2.78 QALYs at an incremental cost of $10,695 but was more cost‐effective, with a cost‐effective ratio of $9893 per QALY compared with $17,149 per QALY for the less experienced center referral strategy. Sensitivity analyses and a Monte Carlo simulation confirmed the robustness of the model. CONCLUSIONS. According to results from the decision‐analysis model, centralized referral of patients with ovarian cancer to an expert center was a cost‐effective healthcare strategy and represents a paradigm for quality cancer care, delivering superior patient outcomes at an economically affordable cost. Increased efforts to align current patterns of care with a universal strategy of centralized expert referral are warranted. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Centralization of care for patients with advanced‐stage ovarian cancer

Bristow

Santillan

Díaz-Montes

et al. 2007

Cancer

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“…15 Cancer management by a multidisciplinary team improves the prognosis of ovarian cancer patients. 14,16,17 The Clinical Resource and Audit Group guideline states that patients who are suspected to have ovarian cancer should be referred in the first instance, either to a gynecological oncologist or to a gynecologist with a special interest in gynecological cancer. 18 Recommendations for centralization of ovarian cancer treatment have been given by The English National Health Service 19,20 and by the Society of Gynecological Oncologists in United States.…”

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confidence: 99%

Evidence of benefit from centralised treatment of ovarian cancer: A nationwide population‐based survival analysis in Finland

Kumpulainen

Grénman

Kyyrönen

et al. 2002

Intl Journal of Cancer

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To assess the effect of different hospital types or surgical volume on the survival of ovarian cancer patients, a nationwide and population-based analysis was carried out in Finland. The study included all 3,851 ovarian cancer patients operated from 1983-94. The patients were classified according to the hospital of the first surgery. The hospitals were categorized by type (university, central or other hospital) and, separately, into quartiles by the number of operated patients (surgical volume). The patients operated at university hospitals had better survival than those operated in central hospitals, the 5-year relative survival rates (RSR) being 45% (95% CI ‫؍‬ 42-48%) and 37% (34 -40%), respectively. RSR in the 'other hospital' category was 45% (42-48%). The RSR for the patients operated in the highest volume hospitals was 47% (43-50%), and by decreasing volume (quartile) the RSR was 40% (36 -43%), 40% (36 -43%) and 42% (38 -45%), respectively. After controlling for potential confounding by stage and age using regression models, the results remained practically the same. The results indicate that further centralizing of operative treatment of ovarian cancer may still improve survival rates on a population level in Finland. © 2002 Wiley-Liss, Inc. Key words: ovarian cancer; survival rates; operative treatment; centralized treatment; optimal care; cancer epidemiologyThe standard treatment of ovarian cancer is cytoreductive surgery followed by combination chemotherapy. Initial surgery is important for accurate staging of the disease and for removing as much of the tumor as possible. The initial operation has been suggested to provide the most important opportunity to affect survival. [1][2][3] Retrospective studies have shown that optimally debulked patients have better survival than suboptimally debulked patients. 1,[3][4][5][6] The highest rates of optimal cytoreduction have been reported to be achieved by gynecologic oncologists. [7][8][9] Comprehensive surgical evaluation of early-stage disease has been reported to be completed in the majority of patients (97%) by gynecologic oncologists, in half of the patients by gynecologists and in one-third of the patients by general surgeons. 10,11 Some of the studies 9,12 but not all 8,13 have shown a survival benefit if the patient has been operated by a gynecologic oncologist. Teaching hospitals have been reported to perform more accurate staging and gathering of data on tumor stage compared to non-teaching hospitals. 11,14 Ovarian cancer patients treated in teaching hospitals had better survival compared to non-teaching hospitals. 15 Cancer management by a multidisciplinary team improves the prognosis of ovarian cancer patients. 14,16,17 The Clinical Resource and Audit Group guideline states that patients who are suspected to have ovarian cancer should be referred in the first instance, either to a gynecological oncologist or to a gynecologist with a special interest in gynecological cancer. 18 Recommendations for centralization of ovarian cancer treatment have bee...

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“…Nearly a third (31%) of the patients were found to have a more advanced stage and 23 of these 31 patients (77%) had stage III disease. Other reports have pointed that specialization of the operating surgeons influence the patient's management and survival [5,[17][18][19][20]. Regarding our data about early EOC, it consistently shows serious deficiencies from the recommended standards of care.…”

Section: Discussionmentioning

confidence: 44%