Association of gynecologic versus medical oncology specialty with survival, utilization, and spending in women with gynecologic cancers

Abstract

<h3>Objectives:</h3> Variation in care between specialists potentially contributes to suboptimal care and increased spending. We examined the association of gynecologic (GYO) versus medical oncology (MEDONC) based care with survival, health care utilization and spending outcomes in women undergoing chemotherapy for advanced gynecologic cancers. <h3>Methods:</h3> Women with newly diagnosed stage III-IV uterine, ovarian, and cervical cancers from 2000-2015 were identified in the SEER-Medicare dataset. Provider specialty was assigned based on plurality of claims associated with chemotherapy infusion visits. For ovarian cancer, we included those that underwent primary debulking surgery. The primary outcome was overall survival (OS) and secondary outcomes were healthcare utilization (ED and admissions per month), and spending per month. We used multi-variable analyses stratified by diagnosis to assess the relationship between specialty and outcomes: cox modeling for OS, Poisson regression for utilization, and generalized linear models of log-transformed data for spending. <h3>Results:</h3> 7937 patients were included (4360 ovarian, 2934 uterine, 643 cervix). 37% were treated by GYO and 63% by MEDONC. For ovarian patients, GYO based care was associated with both improved OS (median OS 3.3 vs 2.9 years; 13% risk reduction for death, p=.0001) and decreased mean spending per month ($4015 vs $4316, 7% reduction, p=.0048), compared to MEDONC in adjusted analyses. For uterine patients, GYO was associated with similar OS compared to MEDONC, but decreased spending per month ($3573 vs $4081, 8% reduction, p=.0089), and decreased ED utilization (11% reduction, p=0.048). For cervix patients, GYO was associated with similar OS compared to MEDONC, but increased spending per month ($6135 vs $5758, 17% increase, p=0.009). Admissions did not differ across groups. (Table 1. * p-value <0.05) <h3>Conclusions:</h3> GYO based care was associated with improved OS and less spending for patients with advanced stage ovarian cancer. For uterine and cervical cancer patients, GYO care was associated with similar OS but less spending in patients with uterine cancer and more spending in those with cervical cancer, compared to MEDONC.