Why Gynecologic Oncologists Are Essential to the Survival of Women with Ovarian Cancer

This year, approximately 23,100 women will be diagnosed with ovarian cancer, and an estimated 14,000 women will die of the disease. Fifty percent of women diagnosed with ovarian cancer will die from the disease within five years, an unacceptably high mortality rate that can in part be mitigated by access to proper specialty care. Over the past two decades, research has shown that referral to a gynecologic oncologist is one of the top factors in increasing ovarian cancer survival rates, as well as decreasing rates of recurrence.

What is a Gynecologic Oncologist?

A gynecologic oncologist is an obstetrician/gynecologist who specializes in the diagnosis and treatment of women with cancer of the reproductive organs. After completing a four-year residency in obstetrics and gynecology, gynecologic oncologists must complete an additional three-year fellowship specializing in precancerous and cancerous conditions of the GYN tract. Surgical skills required to properly stage and remove the majority of the tumor, as well as chemotherapy and radiation therapy techniques are learned and practiced at the highest skill level. This training uniquely qualifies gynecologic oncologists to care for women with cancer of the reproductive tract.

Gynecologic Oncologists Provide Advanced Surgical Care

• The preeminent standard of care for women with ovarian cancer includes definitive surgical staging and optimal tumor removal.

Recent reports generated in the United States have documented the superiority of surgical staging and overall survival in early and advanced stages of ovarian cancer when the surgery was performed by a gynecologic oncologist. The National Cancer Institute agrees with this statement, and further states that surgical intervention is best conducted by a qualified gynecologic oncologist when there is a high probability of ovarian carcinoma. 1

• A study done on the management of ovarian cancer showed that gynecologic oncologists were almost five times more likely to completely debulk ovarian tumors than were their non-specialist counterparts.

In fact, many general surgeons were found to have only performed a biopsy, leaving patients with a stronger likelihood of retaining residual disease of greater than 2 cm after the operation.2 Women whose tumors have been reduced to less than 2 cm have been shown to have a better response to chemotherapy and improved survival rate.3

• A 1993 study showed that gynecologic oncologists were twice as likely to perform the multiple peritoneal and lymph node biopsies necessary to permit adequate surgical staging than were other surgeons.

The absence of lymphadenecotomy and assignment of histologic grade are the primary reasons up to 75 percent of women with presumptive stage I and II ovarian cancer do not receive proper staging and treatment.5

• According to a study done by the American College of Surgeons, almost 80 percent of women with ovarian cancer are treated by non-gynecologic oncologist surgeons who perform adequate surgical staging in 12 to 25 percent of the patients they treat.

In a review of ovarian cancer cases referred by nononcologists, it was found that grossly inaccurate staging information often was obtained.4

• Another study published in 1992 showed older women in particular suffered when a non-specialist performed their surgery.

Seventy-nine percent (34 out of 43) of women older than 65 years old operated on by gynecologic oncologists had the majority of their tumors surgically removed, compared to only 15 percent (9 of 60) operated on by other physicians. Gynecologic oncologists also more frequently performed procedures that were required to attain optimal tumor removal for women whose cancer has spread to their intestines or diaphragm.3

Improved Survival Rates with Surgery by a Gynecologic Oncologist:

• A 1999 Scottish study showed significant benefits for women treated by gynecologic oncologists, especially for the 44 percent of women who present at stage III.

This study, based on 621 deaths over seven years, showed a reduction in death rates of 25 percent for those women operated on by a gynecologic oncologist, and a 32 percent increase in death rates for women operated on by other surgeons. In addition, women treated by a gynecologic oncologist showed mean survival rates of one-third longer than those treated by OB/GYNs. The authors of this study suggest that the incredible success rates of gynecologic oncologists are probably due to three factors: the extent of surgery, more success in removing the majority of the tumor, and more effective chemotherapy.6

• This 1999 study also showed that women with stage III cancer treated by gynecologic oncologist had a mean survival of 18 months, compared with 13 months for those treated by gynecologists.

Since 66 percent of ovarian cancer deaths occur in women with stage III disease, any improvement in this group makes a substantial contribution to overall improvement in survival for women with ovarian cancer, and would justify the need for gynecologic oncolgists6

• Five-year survival and disease-free intervals for women whose surgeon was a gynecologic oncologist far surpass the rates for women treated by nononcologist, OB/GYN groups.

Women whose surgery was performed by a gynecologic oncologist had five-year survival rates after surgical treatment only, which parallel those rates found in studies of women utilizing radiation or chemotherapy in addition to their surgery. One reason behind these startling statistics is the fact that frequently nononcologic surgeons overlook ovarian malignancy in the preoperative clinical dignosis of a pelvic mass.7

The improved survival of women whose surgeries are performed by gynecologic oncologists is a result of their tendency to perform more aggressive surgical techniques, and consequently realize more optimal outcomes. Treatment by a physician other than a gynecologic oncologist can lead to compromises in care and survival, and increased costs due to unnecessary and inadequate procedures and treatments.

Resources for additional information
Society for Gynecologic Oncologists 
Gynecologic Cancer Foundation 1-800-444-4441
Women’s Cancer Network 

Sources

1. Podratz, K.C., Gynecologic Oncology: On the Eve of the New Millennium, Gynec. Oncol. 74, 157-162 (1999); Ovarian Cancer: Screening, Treatment, and Followup, NIH Consensus Statement. Volume 12 (3), 1-14 (1994).
2. Junor, E.J., Hole, D.J., Gillis, C.R. Management of Ovarian Cancer: Referral to a Multidisciplinary Team Matters, British Journal of Cancer. 70(2), 363-370 (1994).
3. Eisenkop, S.M., Spirtos, N.M., Montag, T.W., Nalick, R.H., Wang, H. The Impact of Subspecialty Training on the Management of Advanced Ovarian Cancer, Gynec. Oncol. 47, 203-209 (1992)
4. Averette, H.E., Hoskins, W., Nguyen, H.N., Boike, G., Flessa, H.C., Chmiel, J.S., Zuber, K., Karnell, L.H., Winchester, D.P. National Survey of Ovarian
Carcinoma: A Patient Care Evaluation Study of the American College of Surgeons, Cancer. 71(4) 1629-1637 (1993).
5. Munoz, K.A., Harlan, L.C., Trimble, E.L. Patterns of Care for Women With Ovarian Cancer in the United States, I. of Clinical Oncol. 15 (11) 3408-3415 (1997).
6. Junor, E.J., Hole, D.J., McNulty, L., Mason, M., Young, J. Specialist Gynaecologists and Survival Outcome in Ovarian Cancer: A Scottish National Study of 1866 Patients, British Journal of Obstetrics and Gynaecology. 106, 1130-1136 (1999).