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--Investigator calls results “alarming.”
Johns Hopkins researchers report that more than half of ovarian cancer surgeries in Maryland are done by surgeons who perform the operation only once or at most four times a year. Previous studies have shown that poor outcomes after such surgery are twice as likely in hospitals with ovarian cancer surgery volumes of fewer than 10 cases per year.
Their report, in the May edition of Gynecologic Oncology, also said nearly half (49.6 percent) of the ovarian cancer procedures were being performed in such hospitals.
In what is believed to be the first review of long-term data on regional access to ovarian cancer surgery specialists, the Hopkins researchers analyzed information provided by the Maryland Health Services Cost Review Commission on ovarian cancer surgeries performed over the last decade. Of 2,417 surgeries by 531 surgeons at 49 hospitals, 56.3 percent (1,360) were performed by so-called “low-volume” surgeons, defined as performing four or less ovarian cancer surgeries per year.
“These are alarming statistics demonstrating that most women in Maryland are not receiving the recognized standard of care for ovarian cancer which has been shown to increase the chance for survival,” says Robert E. Bristow, M.D., director of the Johns Hopkins Ovarian Cancer Center. “Women facing a life-threatening illness such as ovarian cancer need to seek out a specialist who concentrates on this disease and treats a high volume of cases.”
Of the entire pool of Maryland surgeons, 91 percent perform an average of one ovarian cancer surgery per year. Surgeons with experience of 5 to 9 cases per year performed 9.2 percent of surgeries, and surgeons with the most experience in ovarian cancer surgery (more than 10 per year) performed 34.5 percent of cases.
“Previous research tells us that ovarian cancer specialists, usually gynecologic oncologists, are much more likely to accurately assess the stage of the disease, which helps determine the treatment most likely to impact survival, especially those with early stage disease or unrecognized advanced disease,” says Bristow. “Even patients with late-stage disease can benefit from advanced surgical techniques to remove as much tumor as possible.”
In the study, the researchers pinpointed several criteria that hindered access to specialty surgical care, namely age, location of residence and insurance carrier. Women younger than 60 and those living more than 50 miles away from a hospital that handles many ovarian cancer cases were less likely to seek help from a specialty surgeon. Women with health maintenance organization (HMO), Medicare or Medicaid coverage also received surgical care less often from gynecologic oncologists.
Surgeons certified in gynecologic oncology typically are able to remove the maximum amount of tumor in 75 percent or more of patients. Surgeons without formal training in specialized tumor removal report rates of 25 percent or less.
To improve access to specialty ovarian cancer care, Bristow said there is a need to educate insurance carriers, increase public and professional awareness of quality care, and implement standardized ovarian cancer treatment and referral guidelines. He has established a Center of Excellence at Johns Hopkins to centralize ovarian cancer research and treatment initiatives.
This study was funded by the Elizabeth Frost Ovarian Cancer Research Fund.
Other participants include Mariana L. Zahurak, Marcela G. del Carmen, Toby A. Gordon, Harold E. Fox, Edward L. Trimble, and F.J. Montz.
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Bristow, Robert E., et. al., “Ovarian cancer surgery in Maryland: volume-based access to care.” Gynecologic Oncology, 93 (2004), 353-360.