Gyn oncologists most effective in treating ovarian Ca

Women with early ovarian cancer receive better care and live longer if their initial treatment is managed by a gynecologic oncologist. So say the results of a cohort study that compared ovarian cancer care delivered by gynecologic oncologists, gynecologists, and general surgeons.

The analysis looked at treatment of more than 3,000 women aged 65 and older who underwent surgery for invasive epithelial ovarian cancer between 1992 and 1999. The data were taken from the Surveillance, Epidemiology, and End Results (SEER) program and from Medicare claims. To assess quality of care, the researchers looked at rates of surgical complications, ostomy, short-term surgical and cause-specific mortality, and overall survival.

One third of the women were operated on by a gynecologic oncologist, 45% by a gynecologist, and 22% by a general surgeon. Women with stage I or II disease were more likely to have lymph node dissection if they went to a gynecologic oncologist than to a gynecologist or general surgeon (60% vs. 36% vs. 16%; P<0.001). Debulking and postoperative chemotherapy were also more common when the first surgery was done by a gynecologic oncologist than by a gynecologist or general surgeon (58% and 79%, respectively, vs. 51% and 76%, and 40% and 62%; P<0.001). A month after the most extensive surgery, the mortality rates for the women treated by the gynecologic oncologists and gynecologists were nearly half that in the group treated by general surgeons: 2.1% versus 4%.

Earle CC, Schrag D, Neville BA, et al. Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients. J Natl Cancer Inst. 2006;98:172-180.