Integration of survivorship program into outpatient gynecologic oncology office setting

Abstract

<h3>Objectives:</h3> To determine the proportion of women with a gynecologic malignancy that complete a survivorship visit when integrating the survivorship program into a routine outpatient gynecologic oncology office visit. <h3>Methods:</h3> In 2017, in an effort to improve the survivorship care for women with gynecologic malignancies, the Program in Women's Oncology at Women and Infants Hospital in Providence, RI instituted a survivorship visit for all patients one month after completion of upfront treatment. This visit took place in the outpatient clinic with the primary gynecologic oncologist present and the nurse practitioner completing the visit. Patients were then referred to subspecialities (nutrition, physical therapy, genetics, urogynecology) for consultation based on needs identified during their survivorship review. We performed a retrospective review of patients completing upfront treatment for gynecologic cancers at our institution. Eligible patients had uterine, ovarian, cervical, or vulvar cancer, and completed treatment with surgery, chemotherapy, radiation, or a combination of these modalities. Records were reviewed to ascertain percentage of patients referred for survivorship visit and the number of patients completing the visit. In addition, we collected information on cancer type and stage, treatment, age, race, and ethnicity. <h3>Results:</h3> 1072 patients with new diagnoses of primary gynecologic cancers were treated between 2017 and 2019 at Women and Infants Hospital. Of these, 30% of patients were referred for survivorship visit. Patients with ovarian cancer had the highest rate of referral for survivorship visit with 51% referred, while patients with vulvar cancer had the lowest rates of referral with 10% referred. 9% of all patients self-identified as race other than White, and of these, 32% were referred for survivorship visit, compared to 30% of patients identifying as White. During the study period, there was an increase in proportion of referrals across all gynecologic cancers from 16% to 39%. <h3>Conclusions:</h3> Survivorship review can be integrated into primary gynecologic oncology office setting to streamline care for patients completing upfront therapy. Further analysis evaluating the impact of stage and specific modality of therapy is warranted to clarify barriers that affect emphasis on transition to survivorship in patients with gynecologic cancers.