Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. May 10, 2016; 5(2): 187-196
Published online May 10, 2016. doi: 10.5317/wjog.v5.i2.187
Gynecologic oncologists involvement on ovarian cancer standard of care receipt and survival
Sun Hee Rim, Shawn Hirsch, Cheryll C Thomas, Wendy R Brewster, Darryl Cooney, Trevor D Thompson, Sherri L Stewart
Sun Hee Rim, Cheryll C Thomas, Trevor D Thompson, Sherri L Stewart, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
Shawn Hirsch, Darryl Cooney, SciMetrika LLC, Durham, NC 27713, United States
Wendy R Brewster, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, United States
Author contributions: Rim SH, Thomas CC and Stewart SL conceived of the study; Rim SH, Hirsch S, Thomas CC, Brewster WR, Cooney D, Thompson TD and Stewart SL wrote the paper and made substantial contributions to the conception, design, data analysis and interpretation of the data; Rim SH, Hirsch S, Thomas CC, Brewster WR and Stewart SL drafted and/or critically reviewed the manuscript for important intellectual content; all authors read and approved the final manuscript.
Supported by The United States Federal Government, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Institutional review board statement: The study was reviewed and approved by the Centers for Disease Control and Prevention Institutional Review Board through an expedited review process in accordance with standard procedures.
Informed consent statement: The Institutional Review Board determined that informed consent was not needed, since the analytic dataset used contained only de-identified patient information and there was no patient contact in this study.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sun Hee Rim, Epidemiologist, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, CDC 4770 Buford Hwy NE MS F-76, Atlanta, GA 30341, United States. srim@cdc.gov
Telephone: +1-770-4880261 Fax: +1-770-4884286
Received: December 4, 2015
Peer-review started: December 4, 2015
First decision: December 28, 2015
Revised: February 26, 2016
Accepted: March 14, 2016
Article in press: March 16, 2016
Published online: May 10, 2016

AIM: To examine the influence of gynecologic oncologists (GO) in the United States on surgical/chemotherapeutic standard of care (SOC), and how this translates into improved survival among women with ovarian cancer (OC).

METHODS: Surveillance, Epidemiology, and End Result (SEER)-Medicare data were used to identify 11688 OC patients (1992-2006). Only Medicare recipients with an initial surgical procedure code (n = 6714) were included. Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile. SOC was defined by a panel of GOs. Multivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOC and proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival.

RESULTS: About 34% received surgery from a GO and 25% received the overall SOC. One-third of women had a GO involved sometime during their care. Women receiving surgery from a GO vs non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC (P < 0.01). Risk of mortality was greater among women not receiving surgical SOC compared to those who did [hazard ratio = 1.22 (95%CI: 1.12-1.33), P < 0.01], and also was higher among women seen by non-GOs vs GOs (for surgical treatment) after adjusting for covariates. Median survival time was 14 mo longer for women receiving combined SOC.

CONCLUSION: A survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported. Persistent survival differences, particularly among those not receiving the SOC, require further investigation.

Keywords: Ovarian neoplasms, Gynecologic oncologist, Guidelines-based care, Surveillance, Epidemiology, and End Result Medicare

Core tip: A significant survival advantage is associated with receiving surgical standard of care (SOC), yet still some women had lower odds of receiving surgical SOC.