Understanding Referral Patterns for Ovarian Cancer

March 14, 2011

Primary care physicians are the entry point for care for many patients. They are often responsible for determining when additional expertise is needed and to which specialist a patient should go for additional care. Although studies have shown that gynecologic oncologists can improve surgical and survival outcomes for patients with ovarian cancer, the referral rate from primary care physicians to gynecologic oncologists remains relatively low.

Primary care physicians are the entry point for care for many patients. They are often responsible for determining when additional expertise is needed and to which specialist a patient should go for additional care. Although studies have shown that gynecologic oncologists can improve surgical and survival outcomes for patients with ovarian cancer, the referral rate from primary care physicians to gynecologic oncologists remains relatively low.

To better understand the factors that lead to referral, Dr Barbara A. Goff, professor and director of gynecologic oncology and adjunct professor in the department of medicine in the division of surgery at the University of Washington, examined characteristics associated with referral. Physicians from 3 primary care specialties-family practice, internal medicine, and obstetrics-gynecology-were presented with a hypothetical patient with abdominal pain and bloating and follow-up ultrasound showing a suspicious ovarian mass. 

Goff found that the referral rates differed among primary care physicians. Less than 40% of family physicians would refer this patient directly to a gynecologic oncologist, and just over 50% of internists said they would refer a patient with a suspicious mass to gynecologic oncologists. In fact, family physicians and internists (39.3% and 51.0%, respectively) reported they were much more likely to refer their patients to obstetrician-gynecologists instead of a gynecologic oncologist.

Obstetrician-gynecologists were most likely to refer patients, with two-thirds reporting that they would refer. The remaining one-third indicated that although they would operate on the patient themselves, they would ask a gynecologic oncologist to consult in the surgery.

Goff found additional characteristics associated with referral to gynecologic oncologists. Female internists were more likely to refer than their male counterparts. Physicians practicing in urban as opposed to rural settings as well as those who were part of a group practice as opposed to a solo practice were also more likely to refer. Interestingly, those with higher patient loads were less likely to refer.

The research brief explained the importance of this study: “Direct referral to gynecologic oncologists for initial surgery, in other studies, correlates with fewer complications and improved survival, in large part because their specialty gives them the high-volume surgical and comprehensive-care experience needed to deliver optimal patient outcomes.”

Goff will be presenting this study and its finding at the Society of Gynecological Oncologists’ 2011 Annual Meeting on Women’s Cancer in Orlando.

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Reference

Goff BA. Ovarian Cancer: Predictors of primary care physicians’ referral to gynecologic oncologists. Research Brief. SGO. March 2011.