Vital Signs Blog

Blog: Quality of ovarian cancer care varies considerably

Less than half of U.S. women being treated for ovarian cancer get care that is up to the national standard, found a report released Wednesday that was commissioned by Congress.

There is “considerable variability,” and one of the most significant factors affecting quality of care is whether a woman is treated by a gynecologic oncologist at a high-volume facility, according to the report from the National Academies of Sciences, Engineering, and Medicine.

The analysis, sponsored by the Centers for Disease Control and Prevention, aimed to assess the body of research on ovarian cancers.

The argument that ovarian cancer patients benefit from being treated at high-volume facilities, has been supported by other research as well.

Findings presented in 2014 at the American Society of Gynecologic Oncology's annual meeting found that women with ovarian and other gynecologic cancers tended to live about one year longer when they received care at hospitals treating larger number of patients with these conditions.

A 2012 study published in the Journal of Clinical Oncology found women who had surgery for ovarian cancer at high-volume hospitals were less likely to die if they experienced complications during surgery.

Despite well-established evidence of the correlation between low volumes and worse patient outcomes, a study in California last year found that 600 cancer surgeries in that state were performed at hospitals that did only one or two of the procedures a calendar year.

The National Academies' committee recommended that clinicians and researchers investigate methods to ensure that standards for ovarian cancers are upheld consistently through access to specialists, surgical management, a chemotherapy regimen and universal genetic testing.

Though relatively rare, the conditions rank fifth in cancer deaths among women, according to the American Cancer Society. An estimated 22,200 women are diagnosed with ovarian cancer each year in the U.S., and more than 14,200 die.

Part of the problem is that the condition is not only difficult to diagnose, but expensive to treat. Roughly two-thirds of women are diagnosed at an advanced stage when the cancer has already spread, the committee of researchers said. A 2011 study estimating the cost of one available treatment found it could reach an average of about $1.3 million per patient.

Adding to the complexity is that even the term “ovarian cancer” is a misnomer. It is not just one disease, but a “constellation of different cancers” involving the ovary, according to the new report. Getting an appropriate classification is complicated because many times the conditions do not originate in the ovary.

“Much remains to be learned,” said the committee chair, Jerome Strauss, also executive vice president for medical affairs and dean of Virginia Commonwealth University School of Medicine in Richmond. Little is understood about basic biology, including where these cancers originate, thus stalling advances in prevention, screening, early detection and treatment, he said.

The committee issued a set of 10 recommendations to fuel understanding of everything from the biology of ovarian cancers, to other factors such as risk assessment, screening, early detection, diagnosis, treatment and supportive care for survivors.

To reduce disparities in quality of care, the committee urged more research to develop better outcome-based quality metrics for cancer. Being able to measure outcomes would help explain why performance varies between high- and low-volume facilities.


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