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Jouranl Article re: Gyn vs Gyn Onc for surgery/treatment

upsofloating's picture
upsofloating
Posts: 473
Joined: Dec 2009

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

Conclusion:

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.

Link to article:
http://www.oncologystat.com/journals/journal_scans/Influence_of_Gynecologic_Oncologists_on_the_Survival_of_Patients_With_Endometrial_Cancer.html

jazzy1's picture
jazzy1
Posts: 1387
Joined: Mar 2010

Annie,

This is very interesting. Question, what doc do people go to if not GO??? I was originally diagnosed via my OB and he in turn, referred me to my oncologist. Oncologists are specialized with cancer and when have schooling as OB that's the best of the best.

Curious....

Jan

upsofloating's picture
upsofloating
Posts: 473
Joined: Dec 2009

Most likely a gynecologist - just not one who subspecializes in oncology exclusively. This means the GO's day-to-day work is all gyn cancers whereas a gyn sees the broad range of gyn issues including well-women check-ups,etc, sort of like the GP of gynecology. I was referred by gyn to gyn onc after endo biopsy results came in.

Ro10's picture
Ro10
Posts: 1474
Joined: Jan 2009

Even though they thought my cancer was in early stages I was referred to a GO. I was surprised a GYN would not do the surgery, since they thought I would just need a hysterectomy since I had no symptoms, but an abnormal PAP. I am so glad she recommended a GO. I did not go with the one she recommended, but did not know how important it was to have a GO.

evertheoptimist
Posts: 140
Joined: Jan 2011

I read a study (forget which one) that demonstrated that skill/expertise/experience of a surgeon who conducted the initial surgery can double the odds for a good prognosis for ovarian cancer patient. It is because ovarian cancer spreads very differently than other types of cancer and it takes a good surgeon to do the debulking surgery well.

UPSC is very much like OVCA (ovarian), and as such, I believe this findings probably apply to UPSC also.

If there is any chance that the uterine cancer may indeed be UPSC rather than the garden variety Uterine Cancer (type I tumor), Da Vince surgery is absolutely a wrong approach. The surgeon needs to have a complete and unimpeded access to the whole abdominal area because his/her clinical impression on the operating table may allow him/her to do what's necessary. This was the case for my gyn oncologist and my surgery.

I am flabbergasted that any OBGYN would ever refer a patient to a generic oncologist. Neither obgyn or generic surgeon or generic oncologist have the necessary training and experience to deal with gynecologic cancer. Especially for UPSC, the sub specialty of the gyn oncologist is very important since UPSC is so much rarer than, say, breast cancer, etc. Most of them probably have never seen a UPSC case. I don't think there is a sub specialty of UPSC, but a good gyn oncologist with subspecialty of OVCA who kept himself up to date will be a good candidate. The optimal treatment protocol for UPSC is very similar to that for OVCA.

I am not surprised that 80% of the women did not receive care from gyn onc. Gyn Oncologists are, comparatively speaking, a special breed, and not every community has one available. Most of us on this forum are highly informed bunch probably coming from above average socioeconomic class. We are better able to advocate for ourselves, and a good portion of us have the means and resources to seek out the right kind of care even if it's not easily available. But how about a woman who lives in a remote rural area in one of the sparsely populated mountain states without the means of traveling to better location for an optimal treatment? Not very likely. Sadly, good doctors and top line treatments are still far more available in wealthy urban communities.

This is the kind of search finding that went into my assertion that the published survival statistics do not apply to me. As a stage 4B UPSC patient, published data for my 5 year survival is low single digit, but I think I will emerge an extreme outlier, and my optimism is not based on delusion and wishful thinking, but a rational ground. I believe the data that went into the calculation is grossly outdated and unrepresentative of the current population of UPSC patients, and on top of that the even in the current population sample, I have every reason to believe that I will be on the far right side of the curve.

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