Almost two-thirds of women missed proper ovarian cancer treatment

Mar 19, 2013

A new study from the University of California reveals only about 37.2 percent of women treated for ovarian cancer are receiving the proper care. WBFO's Eileen Buckley talked to a cancer expert from Roswell Park Cancer Institute about why some woman are missing the mark when it comes to following the national treatment guidelines.

"It's certainly a wakeup call to all health care providers and patients as well, that adherence to the national comprehensive clinical practice guidelines will improve care," said Dr. Peter Frederick, assistant professor of Oncology at Roswell's  Gynecologic Department.

The study pointed out that many woman, who suffered from ovarian cancer, didn't receive adequate care, including treatments that could have extended their lives. 

"High volume hospitals and high volume surgeons definitely were able to provide the best care with this particular cancer, ovarian cancer," said Dr. Frederick.  "Unfortunately not every community across the country has the benefit of a high volume hospital or a high volume surgeon."

When a women are diagnosed they often rely on their gynecologist to conduct the surgery.  But in some cases they need a gynecologic oncologist.

"The treatment for ovarian cancer really involves two main approaches," said Dr. Frederick. "Many women go to their gynecologist for their annual examine for years, and they develop a comfort level with their gynecologist, but it is important if a woman is diagnosed, they want to ask questions about the number of surgeries their surgeon has performed."

Ovarian cancer still considered a rare disease, but according to the American Cancer Society, more than 14,000 women in the United States will die from the disease this year. 

At Roswell, about 100 women a year are being treated for the disease. 

Dr. Frederick highly suggests seeking second opinion if diagnosed with ovarian cancer.  

NCCN treatment guidelines for ovarian cancer:  A population-based validation study of structural and process quality measures:  R. Bristow, J. Chang, A. Ziogas, H. Anton-Culver University of California Irvine - Medical Center, Orange, CA

Objective: To identify structural healthcare characteristics predictive of adherence to National Comprehensive Cancer Network (NCCN) guideline care for ovarian cancer and to validate guideline adherence as a quality process measure associated with improved survival.

Methods: Consecutive patients diagnosed with epithelial ovarian cancer between 1/1/99 and 12/31/06 undergoing a minimum surgical procedure of oophorectomy were extracted from the California Cancer Registry. Adherence to NCCN guideline care was defined by stage-appropriate surgical procedures and recommended chemotherapy. Multivariate logistic regression models were used to identify patient, disease-related, and treatment characteristics independently predictive of NCCN guideline adherence and overall survival.Results: A total of 13,321 patients were identified. Overall, 37.2% received NCCN guideline-adherent care. High-volume hospitals (≥20 cases/year)accounted for 18.8% of cases, and 16.4% of surgeries were performed by high volume surgeons (≥10 cases/year). The structural healthcare characteristic most predictive of NCCN guideline adherence was annual ovarian cancer case volume. High-volume hospitals were significantly more likely to deliver guideline-adherent care (50.8%) compared to low-volume hospitals (34.1%,<0.001). High-volume surgeons were significantly more likely to deliver guideline- adherent care (47.6%) compared to low-volume surgeons (34.5%,<0.001). After controlling for other factors, both low-volume hospitals (odds ratio [OR]=1.83, 95% CI=1.66-2.01) and low-volume surgeons (OR=1.19, 95%CI=1.07-1.32) were independently associated with deviation from NCCN guidelines. On multivariate survival analysis controlling for patient, disease related,and healthcare system factors, non adherence to NCCN guideline care was independently associated with inferior overall survival (hazard ratio[HR]=1.34, 95% CI=1.26-1.42). Both low-volume hospitals (HR=1.08, 95%CI=1.01-1.16) and low-volume surgeons (HR=1.18, 95% CI=1.09-1.28) were independently associated with worse overall survival after adjusting for NCCN guideline adherence.

Conclusions: Adherence to NCCN guidelines for treatment of ovarian cancer is correlated with overall survival and may be a useful process measure of quality cancer care. High-volume providers are significantly more likely to provide NCCN guideline-adherent care and are associated with improved survival outcomes. Ovarian cancer case volume may be a useful structural measure of quality cancer care. Increased efforts to concentrate ovarian cancer care are warranted.