A population-based study of patterns of care for ovarian cancer: who is seen by a gynecologic oncologist and who is not?

OBJECTIVES: To determine the fraction of patients diagnosed with ovarian cancer and seen by a gynecologic oncologist and to compare outcomes with those patients and others who are not seen by a gynecologic oncologist.
METHODS: The statewide, population-based Utah Cancer Registry was used to identify 848 patients diagnosed with epithelial ovarian cancer between 1992 and 1998. Differences between selected characteristics of cases seen/not seen by gynecologic oncologists were assessed with chi2 tests, and survival data were analyzed using Kaplan-Meier curves and log-rank testing.
RESULTS: Of 848 incident epithelial ovarian cancer cases diagnosed in Utah residents during the period 1992-1998, 333 (39.3%) were seen by a gynecologic oncologist at some time during their cancer diagnosis and/or treatment. The percentage of ovarian cancer cases seen by a gynecologic oncologist varied with age: 35.6% of cases under 40 years of age at diagnosis were seen by a gynecologic oncologist, as were 54.5% of cases 40-59 years of age, 42.6% of cases 60-69 years, and 23.7% of women 70+ years of age (chi2 test, P < 0.01). The percentage of ovarian cancer cases seen by a gynecologic oncologists increased during the study period, from 33.0% in 1992-1993 to 47.5% in 1997-1998 (chi2 test for trend, P < 0.01). The vast majority of the state's population resides within a contiguous, four-county area near the only major city where gynecologic oncology care is available. Ovarian cancer cases that resided within that geographic area were generally more likely to have been seen by a gynecologic oncologist than those who lived in more rural regions of the state (42.7 and 27.1%, respectively; chi2 test, P < 0.01). For ovarian cancer cases diagnosed with local or regional stages of disease, there were no significant differences in survivorship between those treated or not treated by gynecologic oncologists. Among cases diagnosed with advanced disease, those cases seen by gynecologic oncologists had a significant survival advantage when compared to those that were not (median survival 26 and 15 months, respectively, P < 0.01).
CONCLUSIONS: Gynecologic oncologists see less than half of ovarian cancer patients. Patients under 40 years of age, over 70 years of age, and in rural areas were significantly less likely to be seen by a gynecologic oncologist in their course of treatment. Patients with advanced disease experienced a significant survival advantage when a gynecologic oncologist was involved in their care.