SAN DIEGO — A retrospective study of 1,491 Northern Californians diagnosed with ovarian cancer from 1994 to 1996 determined that women with the disease were likely to live significantly longer if treated by a gynecologic oncologist.
Women in the care of these cancer subspecialists had a 5-year survival rate of 39%, Dr. John K. Chan reported at the annual meeting of the Society of Gynecologic Oncologists. In comparison, 30% of women treated by other physicians survived 5 years in the study of patients in the California Cancer Registry.
“Treatment by a gynecologic oncologist is an independent prognostic factor for improved survival,” said Dr. Chan, newly appointed director of gynecologic oncology at the University of California, San Francisco.
He worked on the study while serving as a faculty member at Stanford (Calif.) University.
Dr. Chan and his colleagues attributed the survival advantage to gynecologic oncologists doing more primary surgery with appropriate staging and giving more chemotherapy. Nearly all the patients in subspecialist care had primary surgery (92%) and chemotherapy (90%), compared with 69% and 70% of those treated by other physicians.
In addition, the women who did not go to a gynecologic oncologist were four times more likely to have unstaged cancers (8% vs. 2%).
“We're just doing the standard treatment—what the guidelines recommend that we do, and what all the national organizations and all the studies prove is efficacious. It is nothing magical,” Dr. Chan said in an interview after his presentation.
He noted that the findings are consistent with many smaller studies that have shown better outcomes in patients treated by gynecologic oncologists. Drawing patients from multiple institutions, the new study provides more demographic detail, he said. Investigators augmented registry data with chemotherapy information from a medical record review and a physician survey.
Despite the extensive literature favoring treatment by gynecologic oncologists, two-thirds of the patients were treated by “others,” a group that was not broken down but is presumed to include general surgeons and ob.gyns. Though the proportion of patients receiving subspecialist care increased from 28% to 36% during the period studied, it was still only 34% overall. Compared with the larger group of women treated by other physicians, the women in the care of gynecologic oncologists were more affluent, more educated, and more often from urban areas. Poorer patients, especially those from rural areas, were less likely to see a gynecologic oncologist.
Looking for factors associated with suboptimal treatment of higher-risk, early-stage cancers, the investigators found 21% of younger patients (up to age 55) with stage IC-II cancers did not receive chemotherapy. They also reported that only 39% of poorer patients and 38% of patients with early-grade tumors received chemotherapy.
“Younger patients who did not receive appropriate treatment were more likely to be classified as poor, less likely to be treated by a gynecologic oncologist, and had more early-grade cancers,” Dr. Chan said, calling for more patient and physician education “to ensure that patients are appropriately referred to subspecialists to achieve comprehensive care.”
In a discussion of the study, Dr. Barbara Goff, secretary-treasurer of the society, reviewed the medical literature and asked why some women still have their procedures by surgeons other than gynecologic oncologists. The society needs to go beyond “preaching to the choir” and become more aggressive in educating other physicians about the importance of referring cancer patients to gynecologic oncologists, said Dr. Goff of the University of Washington, Seattle.
“We need to do a better job of promoting this agenda,” she said.