Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Vermillion, Inc, Austin, TX.
Am J Obstet Gynecol. 2018 Apr;218(4):436.e1-436.e7. doi: 10.1016/j.ajog.2018.01.015. Epub 2018 Jan 17.
Patients with ovarian cancer tend to receive the highest quality of care at high-volume cancer centers with gynecological oncologists. However, the care that they receive prior to gynecological oncology consult has not been examined. We investigated the quantity and quality of care given to patients with ovarian cancer before being seen by a gynecological oncologist.
We evaluated the variability, quantity, and quality of diagnostic testing and physician-referral patterns prior to consultation with a gynecological oncologist, in women with suspicious pelvic masses seen on imaging.
A chart review was performed on patients treated for ovarian cancer at a single institution from 2001 to 2014. We evaluated their workup in 4 categories, drawn from National Comprehensive Care Network guidelines: provider visits, abdominal/pelvic imaging, chest imaging, and tumor markers. Workup was classified as guideline adherent or guideline nonadherent.
We identified 335 cases that met our criteria. In the provider visit category, 83.9% of patients received guideline-adherent workup: 77% in the abdominal/pelvic imaging, 98.2% in the chest imaging, and 95.2% in the tumor marker categories. Each patient's workup was assessed as a compilation of the 4 categories, yielding 65.7% patients as having received an adherent workup and 34.3% of workup as nonadherent to guidelines. The timeframe to see a gynecological oncologist for patients with guideline-adherent workup was significantly shorter than for those whose workup was nonadherant (20 vs 86 days, P < .001). A suspicious pelvic mass was identified by obstetrics-gynecology in only 23.9% of patients; 42.7% of patients did not have tumor marker testing before a gynecological oncologist consult. When an obstetrics-gynecology specialist discovered the suspicious pelvic mass, the remaining workup was more likely to be guideline adherent prior to gynecological oncologist referral than when initial imaging was not ordered by an obstetrics-gynecology specialist (P = .18). Survival was not significantly different (P = .103).
With a guideline-adherent workup, including tumor marker testing, gynecological oncologist referral times can be shortened, minimizing cost inefficiencies and delays that can compromise the effectiveness of downstream care for patients with ovarian cancer. Guidelines should be disseminated beyond the obstetrics-gynecology field.
卵巢癌患者在肿瘤量大且有妇科肿瘤医生的癌症中心接受的护理质量最高。然而，他们在接受妇科肿瘤医生咨询之前接受的护理尚未得到检查。我们调查了在接受妇科肿瘤医生咨询之前，卵巢癌患者接受的护理的数量和质量。
我们评估了在妇科肿瘤医生咨询之前，对影像学检查发现可疑盆腔肿块的女性，进行诊断性检查和医生转诊的数量和质量的可变性。
对 2001 年至 2014 年在一家机构接受卵巢癌治疗的患者进行了病历回顾。我们根据国家综合护理网络指南，从以下 4 个类别评估了他们的检查：就诊次数、腹部/盆腔影像学检查、胸部影像学检查和肿瘤标志物。检查分为符合指南和不符合指南。
我们确定了符合标准的 335 例病例。在就诊次数类别中，83.9%的患者接受了符合指南的检查：77%的患者进行了腹部/盆腔影像学检查，98.2%的患者进行了胸部影像学检查，95.2%的患者进行了肿瘤标志物检查。每位患者的检查都被评估为这 4 个类别的综合结果，结果 65.7%的患者接受了符合指南的检查，34.3%的检查不符合指南。符合指南的检查患者就诊于妇科肿瘤医生的时间明显短于不符合指南的患者（20 天 vs 86 天，P<.001）。只有 23.9%的患者通过妇产科发现可疑盆腔肿块；42.7%的患者在妇科肿瘤医生咨询前没有进行肿瘤标志物检查。当妇产科专家发现可疑盆腔肿块时，与最初影像学检查不是由妇产科专家下医嘱的情况相比，妇科肿瘤医生转诊前的其余检查更有可能符合指南（P=.18）。生存情况无显著差异（P=.103）。
如果进行符合指南的检查，包括肿瘤标志物检查，妇科肿瘤医生的转诊时间可以缩短，从而最大限度地减少成本效率低下和延误，这些延误可能会影响卵巢癌患者下游护理的有效性。指南应在妇产科领域之外传播。
