What changes in the organisation of cancer services will improve the outcome for women with ovarian cancer?

Objective To examine the influence of operator specialty, volume of work and referral to an oncologist on the survival of women with ovarian cancer. Design Population-based retrospective cohort study, using hospital records and Cancer Registry data. Setting The North Western Region, UK. Population Six hundred and ninety-one women undergoing laparotomy for histologically confirmed ovarian malignancy during 1991 to 1992. Methods Univariate and multivariate survival analyses. Main outcome measures Univariate survival estimates. Relative risks, derived from Cox's proportional hazards model, describing the effect on survival of surgeons vs gynaecologists as baseline, high volume vs low volume operators and referral vs nonreferral to an oncologist. Results After adjusting for woman and disease-related prognostic factors, operation by a surgeon was shown to have an adverse impact on survival (RR = 1.58, 95% CI 1.19 to 2.10). Regardless of how a high volume operator was defined (in terms of the number of laparotomies performed), no survival advantage over low volume operators could be demonstrated. Women referred to an oncologist had significantly better survival than women not referred (RR = 0.54, 95% CI 0.43 to 0.68) Conclusions All women undergoing surgery for ovarian cancer should have access to a gynaecological opinion and postoperatively should be referred for a nonsurgical oncological opinion.