ReviewVariations in institutional infrastructure, physician specialization and experience, and outcome in ovarian cancer: A systematic review
Introduction
Ovarian cancer is the leading cause of death among all gynecologic cancers. The lifetime risk varies between 1.1 and 1.6 in Europe and the United States [1]. The majority of affected women die from this disease, and overall 5-year-survival rates are still only 48.4% for Federation Internationale de Gynecologie et d'Obstetrique (FIGO) stages I–IV [2]. Five-year-survival rates differ substantially, however, among European countries, ranging from 25.6% in Estonia to 51.4% in Iceland for patients diagnosed between 1990 and 1994 [3].
The chance of surviving ovarian cancer mainly depends on three variables: (1) patient characteristics, (2) tumor biology, and (3) quality of treatment (e.g., surgical outcome, chemotherapy selection). The first two reflect the unchangeable reality of the patient, but the latter is amenable for direct influence, and therefore, seems to be of utmost importance when considering efforts aiming at improvement in the outcome of this disease. The diversity of treatment results might be related to variations in institutional infrastructure, national training and education programs, and physician's specialization and experience. However, only sporadic information about the relationship between the above-mentioned factors and treatment outcome is available. The first review published in 1998 reported a positive impact of specialization on survival in ovarian cancer [4]; however, this review included only seven rather heterogeneous studies available at that time. Since then, more data are available and, therefore, we performed a systematic review to evaluate whether different institutional and physician-related variables have any impact on outcome in ovarian cancer patients. The following hierarchical questions were defined upfront: Are there any institution or physician characteristics that are associated with
- 1.
Superior survival?
- 2.
Superior surgical outcome with respect to tumor debulking?
- 3.
Superior surgical outcome with respect to completeness of staging?
- 4.
Superior compliance with guidelines regarding selection of chemotherapy regimens?
Section snippets
Data sources
We searched MEDLINE for literature published between 1 January 1980 and 31 July 2007, using the following algorithm: “ovarian neoplasms” [MeSH Terms] AND (patterns of care [Text Word = TW] OR quality of health care [TW] OR audit [TW] OR centralization [TW] OR centralisation [TW] OR centralized treatment [TW] OR centralised treatment [TW] OR specialization [TW] OR specialisation [TW] OR specialty [TW] OR specialties [TW] OR specialist [TW] OR gynecologic oncologist [TW] OR gynecological oncologist
Literature review and inclusion criteria
One hundred ninety-eight publications were identified in MEDLINE through our search algorithm. Of the identified publications, 38 were considered relevant according to the inclusion criteria [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42]. The screening of the bibliographies of the articles retrieved from the electronic
Discussion
Surgery and chemotherapy are the mainstays in the treatment of both early and advanced ovarian cancer. Several guidelines and consensus statements outlining detailed surgical, as well as chemotherapeutical procedures, have been published in the US and worldwide [53], [54], [55]. However, adherence to these treatment recommendations is poor even in countries with established training programs in gynecologic oncology [15], [28]. Completeness of tumor resection and comprehensive staging are of
Conflict of interest statement
The authors have no conflicts of interest to declare.
Acknowledgments
The authors want to thank all authors and co-workers of the articles included; and especially those who provided original data, further details and analysis or explanations regarding their published articles: K. Bertelsen and R. dePont Christensen, C. Earle and B. Neville, L. Elit, B. M. Engelen, Goff, D. Hole, A. Ioka, S. Kumpulainen and R. Sankila, A. Olaitan and A. Mocroft, T. Paulsen, M. Quinn and V. Thursfield, I. Skirnisdottir and B. Sorbe, D. Stockton, S. Tingulstad and F. Skjeldestad,
References (88)
- et al.
Does specialist do it better? The impact of specialisation on the processes and outcomes of care for cancer patients
Ann. Oncol.
(1998) - et al.
Assessment of morbidity and mortality in primary cytoreductive surgery for advanced ovarian carcinoma
Gynecol. Oncol.
(1985) - et al.
Medical audit, cancer registration, and survival in ovarian cancer
Lancet
(1991) - et al.
The impact of subspecialty training on the management of advanced ovarian cancer
Gynecol. Oncol.
(1992) - et al.
Ovarian cancer staging: does it require a gynecologic oncologist?
Gynecol. Oncol.
(1992) - et al.
Management and survival of ovarian-cancer patients in South East England
Eur. J. Cancer.
(1997) - et al.
A population-based study of patterns of care for ovarian cancer: who is seen by a gynecologic oncologist and who is not?
Gynecol. Oncol.
(2002) - et al.
Outcomes in surgery for ovarian cancer
Gynecol. Oncol.
(2002) - et al.
The effect of centralization of primary surgery on survival in ovarian cancer patients
Obstet. Gynecol.
(2003) - et al.
Survival for Californian women with epithelial ovarian cancer, 1994–1996: a population-based study
Gynecol. Oncol.
(2003)
Surgical treatment of ovarian cancer in different hospital categories — a prospective nation-wide study in Finland
Eur. J. Cancer
Outcomes for systemic therapy in women with ovarian cancer
Gynecol. Oncol.
Tumor reduction surgery and long-term survival in advanced ovarian cancer: a DACOVA study
Gynecol. Oncol.
Survival and prognostic factors in patients with ovarian cancer
Obstet. Gynecol.
Influence of department volume on cancer survival for gynaecological cancers — a population-based study in Tyrol, Austria
Gynecol. Oncol.
Advanced epithelial ovarian cancer: 1998 consensus statements
Ann. Oncol.
2004 Consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004)
Ann. Oncol.
The accuracy of staging: an important prognostic determinator in stage I ovarian carcinoma
Ann. Oncol.
The benefits of comprehensive surgical staging in the management of early-stage epithelial ovarian carcinoma
Gynecol. Oncol.
Reasons for incomplete surgical staging in early ovarian carcinoma
Gynecol. Oncol.
Laparotomy to complete staging of presumed early ovarian cancer
Obstet. Gynecol.
The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma
Am. J. Obstet. Gynecol.
Tumour reduction and chemotherapy in ovarian cancer
Bailliere's Clin. Obstet. Gynaecol.
The specialty of gynecologic oncology as perceived by the public
Gynecol. Oncol.
Effect of surgeon's experience on the surgical outcome of laparoscopic surgery for women with endometrial cancer
Gynecol. Oncol.
Influence of clinician workload and patterns of treatment on survival from breast cancer
Lancet
Comparison of outcomes in cancer patients treated within and outside clinical trials: conceptual framework and structured review
Lancet
Who should operate on patients with ovarian cancer? An evidence-based review
Gynecol. Oncol.
The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review
Gynecol. Oncol.
Carcinoma of the ovary
Survival of cancer patients in Europe: the EUROCARE-3 study
Ann. Oncol.
Misstaging of ovarian cancer
Obstet. Gynecol.
Process and outcome of care for patients with ovarian cancer
Br. Med. J.
Patterns of care in carcinoma of the ovary
Cancer
National survey of ovarian carcinoma. Part V. The impact of physician's specialty on patients' survival
Cancer
The influence of the operating surgeon's specialisation on patient survival in ovarian carcinoma
Br. J. Cancer
What changes in the organisation of cancer services will improve the outcome for women with ovarian cancer?
Br. J. Obstet. Gynaecol.
Patterns of care for women with ovarian cancer in the United States
J. Clin. Oncol.
Stage I ovarian carcinoma: specialty-related differences in survival and management
South. Med. J.
The current status of surgical staging of ovarian serous borderline tumors
Cancer
Specialist gynaecologists and survival outcome in ovarian cancer: a Scottish national study of 1866 patients
Br. J. Obstet. Gynaecol.
Multiple cancer site comparison of adjusted survival by hospital of treatment: an East Anglian study
Br. J. Cancer.
The surgical management of women with ovarian cancer in South West of England
Br. J. Cancer.
Cited by (172)
Association between hospital volume and outcomes in invasive ovarian cancer in Belgium: A population-based study
2023, European Journal of CancerImpact of care by gynecologic oncologists on primary ovarian cancer survival: A population-based study
2022, Gynecologic OncologyGynecologic oncologist impact on adjuvant chemotherapy care for stage II-IV ovarian cancer patients
2022, Gynecologic OncologyAn increase in multi-site practices: The shifting paradigm for gynecologic cancer care delivery
2021, Gynecologic Oncology