According to a study published in the Journal of the National Cancer Institute, ovarian cancer patients treated by gynecologic oncologists have somewhat better outcomes than ovarian cancer patients treated by general gynecologists. Patients treated by gynecologic oncologists also have clearly better outcomes than those treated by general surgeons. A related study published in the same issue found no strong link between the number of ovarian cancer patients treated by a physician or hospital and ovarian cancer outcomes.
The relationship between patient outcomes and the number of patients seen at a particular hospital or by a particular doctor has received a great deal of attention over the past 25 years. In general, studies report that “high-volume” hospitals and doctors (hospitals and doctors who treat more patients with a particular condition) have better patient outcomes for specific conditions.
In the case of ovarian cancer, studies have also suggested that highly specialized physicians (gynecologic oncologists) are more likely to perform recommended ovarian cancer surgery than less specialized physicians; they may therefore more accurately assess the stage of the cancer. Accurate cancer staging is a critical component of treatment planning.
To evaluate the relationship between physician specialty and ovarian cancer outcomes, researchers evaluated 3067 ovarian cancer patients diagnosed between 1992 and 1999. All patients were 65 years of age or older. Thirty three percent of the patients were treated by a gynecologic oncologist, 45% of patients were treated by a general gynecologist, and 22% were treated by a general surgeon.
- Among patients with stage I or stage II ovarian cancer, recommended lymph node dissection was provided to 60% of patients treated by a gynecologic oncologist, 36% of patients treated by a general gynecologist, and 16% of patients treated by a general surgeon.
- Among patients with stage III or stage IV ovarian cancer, initial surgery included debulking (removal of as much of the tumor as possible) in 58% of patients treated by a gynecologic oncologist, 51% of patients treated by a general gynecologist, and 40% of patients treated by a general surgeon.
- Compared to patients treated by a general surgeon, risk of death was 15% lower in patients treated by gynecologic oncologists, and 14% lower in patients treated by general gynecologists.
The researchers conclude “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.”
A related study published in the same issue assessed the relationship between provider and hospital volume and ovarian cancer survival. The study used the same database as the study above to identify ovarian cancer patients. There was no strong link between the volume of patients seen by a surgeon or hospital and survival after ovarian cancer surgery.
The researchers conclude that “Hospital- and surgeon-specific procedure volumes are not strong predictors of survival outcomes following surgery for ovarian cancer among women aged 65 years or older.”
An editorial that accompanies these two studies cautions that both studies evaluated only older ovarian cancer patients. It’s unclear whether the results of these studies will apply to younger ovarian cancer patients.
Schrag D, Earle C, Xu F et al. Associations Between Hospital and Surgeon Procedure Volumes and Patient Outcomes After Ovarian Cancer Resection. Journal of the National Cancer Institute. 2006;98:163-171.