Abstract
A system-level organizational guideline for gynecologic oncology was identified by a provincial cancer agency as a key priority based on input from stakeholders, data showing more limited availability of multidisciplinary or specialist care in lower-volume than in higher-volume hospitals in the relevant jurisdiction, and variable rates of staging for ovarian and endometrial cancer patients. A systematic review assessed the relationship of the organization of gynecologic oncology services with patient survival and surgical outcomes. The electronic databases medline and embase (ovid: 1996 through 9 January 2015) were searched using terms related to gynecologic malignancies combined with organization of services, patterns of care, and various facility and physician characteristics. Outcomes of interest included overall or disease-specific survival, short-term survival, adequate staging, and degree of cytoreduction or optimal cytoreduction (or both) for ovarian cancer patients by hospital or physician type, and rate of discrepancy in initial diagnoses and intraoperative consultation between non-specialist pathologists and gyne-oncology-specialist pathologists. One systematic review and sixteen additional primary studies met the inclusion criteria. The evidence base as a whole was judged to be of lower quality; however, a trend toward improved outcomes with centralization of gynecologic oncology was found, particularly with respect to the gynecologic oncology care of patients with advanced-stage ovarian cancer. Improvements in outcomes with centralization of gynecologic oncology services can be attributed to a number of factors, including access to specialist care and multidisciplinary team management. Findings of this systematic review should be used with caution because of the limitations of the evidence base; however, an expert consensus process made it possible to create recommendations for implementation.
Highlights
The annual incidence of gynecologic cancers exceeds a million cases worldwide, with half a million deaths annually1
Improvements in outcomes with centralization of gynecologic oncology services can be attributed to a number of factors, including access to specialist care and multidisciplinary team management
The present systematic review was designed to assess the relationship of the organization of gynecologic oncology services with patient survival, surgical outcomes, the delivery of chemotherapy, and some aspects of the role of specialist pathologists in gynecologic oncology
Summary
The annual incidence of gynecologic cancers exceeds a million cases worldwide, with half a million deaths annually. The present systematic review was designed to assess the relationship of the organization of gynecologic oncology services with patient survival, surgical outcomes, the delivery of chemotherapy, and some aspects of the role of specialist pathologists in gynecologic oncology. This choice of topic was based on perceived issues, including the absence of a health care system–wide network of care and a lack of collaboration, even in a setting in which most gynecologic oncologists are practicing in major centres with teaching hospitals and using a multidisciplinary team approach. A system-level organizational guideline for gynecologic oncology was identified by a provincial cancer agency as a key priority based on input from stakeholders, data showing more limited availability of multidisciplinary or specialist care in lower-volume than in higher-volume hospitals in the relevant jurisdiction, and variable rates of staging for ovarian and endometrial cancer patients
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