The benefits of a gynecologic oncologist: a pattern of care study for endometrial cancer treatment

Objective. Compare important aspects of initial endometrial cancer treatment in women with or without primary management by a gynecologic oncologist (GYO). Methods. A retrospective pattern of care study was conducted using minor registry data from a community-based health care system. Surgically treated endometrial cancer cases were reviewed with respect to histology, training of surgeon(s), procedures, TNM staging, and prescription of adjuvant radiation. Results. Two hundred and seven consecutive cases completed between January 1998 and December 2000 were analyzed. Overall surgical stage was 78.4% stage I, 6.9% stage II, and 14.7% stage III-IV. Gynecologic oncologists (GYOs) provided care in 101 (48.8%) and gynecologists (GYNs) in 104 cases (50.2%). General surgeons (GSs) assisted gynecologists in 36.5% of cases. GYOs (94.0%) completed TNM staging two times more frequently (P < 0.05) than GYNs (45.2%). The incidence of lymph node assessment by GYOs was 83.0% (average number of nodes, 19.5) and GYNs 26.0% (average number of nodes, 7.7). Advanced disease (stage III-IV) was more frequently (P< 0.05) managed by GYOs (23.0%) than GYNs (6.7%). Radiation (RT) was prescribed to 36 (17.4%) patients. When evaluating TI and TII tumors at risk for extrauterine spread (G2-G3 or myometrial invasion), GYOs completed surgical staging more frequently than GYNs (95.7% vs. 18.8%, P < 0.05). GYO patients received radiation (six patients: 8.6%) less frequently than GYN patients (8.6% vs. 21.7%). No patient managed by GYOs with TI NO disease received RT. Eighteen percent of patients managed by GYNs with T1 N0 or T1 NX received RT. Conclusions. Gynecologic oncologists are more likely to evaluate and manage those with advanced endometrial cancer. Women with endometrial cancer managed by GYOs are more likely to receive comprehensive TNM surgical staging. The employment of complete TNM staging by GYOs reduced the use of RT in those with T1 N0 or Nx disease by 100%. These results suggest that primary management by gynecologic oncologists results in an efficient use of health care resources and minimized the potential morbidity associated with adjuvant radiation. (C) 2004 Elsevier Inc. All rights reserved.