title: Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients.
abstract: BACKGROUND
  For many diseases, specialized care (i.e., care rendered by a specialist) has been associated with superior-quality care (i.e., better outcomes). We examined associations between physician specialty and outcomes in a population-based cohort of elderly ovarian cancer surgery patients.
  
  
  METHODS
  We analyzed the Medicare claims, by physician specialty, of all women aged 65 years or older who underwent surgery for pathologically confirmed invasive epithelial ovarian cancer between January 1, 1992, and December 31, 1999, while living in an area monitored by the Surveillance, Epidemiology, and End Results (SEER) program to assess important care processes (i.e., the appropriate extent of surgery and use of adjuvant chemotherapy) and outcomes (i.e., surgical complications, ostomy rates, and survival). All statistical tests were two-sided.
  
  
  RESULTS
  Among 3067 ovarian cancer patients who underwent surgery, 1017 patients (33%) were treated by a gynecologic oncologist, 1377 patients (45%) by a general gynecologist, and 673 patients (22%) by a general surgeon. Among patients with stage I or II disease, those treated by a gynecologic oncologist (60%) were more likely to undergo lymph node dissection than those treated by a general gynecologist (36%) or a general surgeon (16%). Patients with stage III or IV disease were more likely to undergo a debulking procedure if the initial surgery was performed by a gynecologic oncologist (58%) than by a general gynecologist (51%) or a general surgeon (40%; P < .001) and were more likely to receive postoperative chemotherapy when operated on by a gynecologic oncologist (79%) or a general gynecologist (76%) than by a general surgeon (62%, P < .001). Survival among patients operated on by gynecologic oncologists (hazard ratio [HR] of death from any cause = 0.85, 95% confidence interval [CI] = 0.76 to 0.95) or general gynecologists (HR = 0.86, 95% CI = 0.78 to 0.96) was better than that among patients operated on by general surgeons.
  
  
  CONCLUSIONS
  Ovarian cancer patients treated by gynecologic oncologists had marginally better outcomes than those treated by general gynecologists and clearly superior outcomes compared with patients treated by general surgeons.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. craig_earle@dfci.harvard.edu
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.forename: Marie
authors.initials: M
authors.lastname: Topor
authors.forename: Angela
authors.initials: A
authors.lastname: Fahey
authors.forename: Edward L
authors.initials: EL
authors.lastname: Trimble
authors.forename: Diane C
authors.initials: DC
authors.lastname: Bodurka
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Michael
authors.initials: M
authors.lastname: Carney
authors.forename: Joan L
authors.initials: JL
authors.lastname: Warren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016001:Confidence Intervals; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006176:Gynecology / Q000706:statistics & numerical data*; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D006278:Medicare; D009367:Neoplasm Staging; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D018426:SEER Program; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology