Feb 15, 2011 - 4:06 pm
Influence of Gynecologic Oncologists on the Survival of Patients With Endometrial Cancer
J Clin Oncol. 2011 Jan 24;[Epub Ahead of Print], JK Chan, AE Sherman, DS Kapp, R Zhang, KE Osann, L Maxwell, LM Chen, H Deshmukh
On multivariate analysis, younger age at diagnosis, early stage, lower grade, and care by a GO were independent prognostic factors for improved DSS.
In a subset analysis of patients with advanced-stage disease, overall survival was significantly improved with GO care (41.8% vs 35.4%; P < .001). The authors suggested that this benefit in overall survival may be due, in part, to greater use of screening for other malignancies with GO care.
The survival benefit associated with GO care in patients with stage II–IV disease may be explained by the GO’s better understanding of the disease process, resulting in more accurate staging, including lymph node dissection, followed by adjuvant treatment, if indicated. GO care did not show a survival benefit for those patients with a favorable prognosis (stage I and grade 1 cancers), probably because advanced staging procedures are less important in these patients. In patients with advanced disease, the benefits of GO care may also be due to cytoreduction of metastatic disease.
The authors recommend that women with endometrial cancer should seek care by a GO to assess the need for surgical staging and guidance for adjuvant therapy after surgery. They noted that nearly 80% of patients in this national study did not receive GO care and that women with lower socioeconomic status were less likely to receive GO care. Thus, further studies are needed to identify the disparities in endometrial cancer treatment and the potential barriers to subspecialty care.
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