摘要
AIM:To examine the influence of gynecologic oncolo-gists(GO) in the United States on surgical/chemotherapeutic standard of care(SOC), and how this translates into improved survival among women with ovarian cancer(OC).METHODS: Surveillance, Epidemiology, and End Result(SEER)-Medicare data were used to identify 11688 OC patients(1992-2006). Only Medicare recipients with an initial surgical procedure code(n = 6714) were included. Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile. SOC was defined by a panel of GOs. Multivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOCand proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival. RESULTS: About 34% received surgery from a GO and 25% received the overall SOC. One-third of women had a GO involved sometime during their care. Women receiving surgery from a GO vs non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC(P < 0.01). Risk of mortality was greater among women not receiving surgical SOC compared to those who did [hazard ratio = 1.22(95%CI: 1.12-1.33), P < 0.01], and also was higher among women seen by non-GOs vs GOs(for surgical treatment) after adjusting for covariates. Median survival time was 14 mo longer for women receiving combined SOC. CONCLUSION: A survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported. Persistent survival differences, particularly among those not receiving the SOC, require further investigation.
AIM: To examine the infuence of gynecologic oncolo-gists (GO) in the United States on surgical/chemothe-rapeutic standard of care (SOC), and how this translates into improved survival among women with ovarian cancer (OC).METHODS: Surveillance, Epidemiology, and End Result (SEER)-Medicare data were used to identify 11688 OC patients (1992-2006). Only Medicare recipients with an initial surgical procedure code (n = 6714) were included. Physician specialty was identified by linking SEER-Medicare to the American Medical Association Masterfile. SOC was defined by a panel of GOs. Mul-tivariate logistic regression was used to determine predictors of receiving surgical/chemotherapeutic SOC and proportional hazards modeling to estimate the effect of SOC treatment and physician specialty on survival. RESULTS: About 34% received surgery from a GO and 25% received the overall SOC. One-third of women had a GO involved sometime during their care. Women receiving surgery from a GO vs non-GO had 2.35 times the odds of receiving the surgical SOC and 1.25 times the odds of receiving chemotherapeutic SOC (P 〈 0.01). Risk of mortality was greater among women not receiving surgical SOC compared to those who did [hazard ratio = 1.22 (95%CI: 1.12-1.33), P 〈 0.01], and also was higher among women seen by non-GOs vs GOs (for surgical treatment) after adjusting for covariates. Median survival time was 14 mo longer for women receiving combined SOC. CONCLUSION: A survival advantage associated with receiving surgical SOC and overall treatment by a GO is supported. Persistent survival differences, particularly among those not receiving the SOC, require further investigation.
基金
Supported by The United States Federal Government,Centers for Disease Control and Prevention,Atlanta,GA,United States
关键词
肿瘤
卵巢
治疗方法
临床分析
Ovarian neoplasms
Gynecologic oncologist
Guidelines-based care
Surveillance
Epidemiology
and End Result Medicare