Specialists provide best outcome for ovarian cancer

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Elderly women with ovarian cancer tend to survive longer if they are treated by gynecologic oncologists rather than by general surgeons, according to the results of a large study review published in the Journal of the National Cancer Institute.

However, the outcomes do not appear to be greatly affected by the volume of ovarian cancer patients seen in hospitals or by individual surgeons, after accounting for factors such as patient age and cancer stage, authors of a second article in the Journal write.

Dr. Craig C. Earle, from the Dana-Farber Cancer Center in Boston, and his colleagues analyzed data from the Surveillance, Epidemiology and End Results (SEER) program for 3,067 women 65 years of age or older who underwent surgery for confirmed invasive ovarian cancer between 1992 and 1999.

These data were linked to Medicare records and American Medical Association files to obtain information about the medical care the women received and the specialty type of the surgeon who performed the cancer-related procedures.

The records showed that 33 percent were operated on by a gynecologic oncologist, 45 percent by a general gynecologist, and 22 percent by a general surgeon.

Patients with earlier stage cancer—stage I or stage II—treated by gynecologic oncologists were more likely to undergo lymph node removal, which was performed by 60 percent of the gynecologic oncologists, 36 percent of the general gynecologists and 16 percent of the general surgeons.

Women treated by gynecologic oncologists and general gynecologists were more likely to undergo a reduction of the tumor mass at the time of their first surgery than those operated on by general surgeons (58 percent, 51 percent and 40 percent, respectively) and to receive chemotherapy after surgery (79 percent, 76 percent and 62 percent).

Even though patients operated on by gynecologic oncologists tended to have more advanced disease at diagnosis, their survival rates were similar to those operated on by general gynecologists and better than those operated on by general surgeons, with average survival times 32.5 months, 35.6 months, and 24.3 months, respectively.

“Our data support professional societies’ recommendations that it is preferable for ovarian cancer patients to be operated on by gynecologic oncologists when possible,” Earle’s group concludes.

In the second paper, researchers led by Dr. Deborah Schrag, from Memorial Sloan-Kettering Cancer Center in New York, conducted a similar analysis. They identified 2,952 patients for whom hospital and physician information could be determined.

Two-year mortality was modestly lower in hospitals with the highest volume of ovarian cancer cases treated (45.2 percent for low volume, 41.1 percent for intermediate volume and 40.4 percent for highest volume). However, the association between hospital procedure volume and two-year mortality was not statistically significant.

Likewise, there was no significant difference between two-year mortality and surgeon procedure volume.

Schrag’s group notes that most patients were treated by surgeons who performed these operations only occasionally.

Based on their findings, they conclude that the variations in outcomes “observed merit further scrutiny to understand the underlying mechanisms that enable higher-volume hospitals and surgeons to achieve more favorable surgical outcomes.”

SOURCE: Journal of the National Cancer Institute, February 1, 2006.

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