Does ovarian cancer treatment and survival differ by the specialty providing chemotherapy?
OBJECTIVE
Chemotherapy for ovarian cancer is usually administered by medical oncologists (MOs) or gynecologic oncologists (GOs). GOs perform a broad spectrum of surgical and medical activities while managing a limited number of diseases; MOs specialize in the administration of chemotherapy but manage a broad array of diseases. We asked whether survival, treatment, and toxicity differed according to the type of specialist providing the chemotherapy after surgery.


METHODS
Using Surveillance, Epidemiology, and End Results (SEER)--Medicare data for patients 65 years old from 1991 through 2001 from eight SEER sites, we identified 344 patients with ovarian cancer who were treated with chemotherapy by a GO after surgery. Using optimal matching and propensity scores based on 36 characteristics, we matched these patients to 344 similar patients who were operated on and staged by the same type of surgeon but who received chemotherapy from an MO.


RESULTS
MOs administered chemotherapy over more weeks than did the GOs (16.5 v 12.1 weeks, respectively; P < .0023), and MO patients had substantially more weeks that included chemotherapy-associated adverse events than GO patients (16.2 v 8.9 weeks, respectively; P < .0001). However, there was no difference in 5-year survival rate between the GO and MO groups (35% v 34%, respectively; P = .45).


CONCLUSIONS
GO- and MO-treated patients who were closely matched on prognostic characteristics experienced very different rates of chemotherapy-associated adverse events and very different chemotherapy treatment styles by specialty type; however, their survival was virtually identical.
Silber
Jeffrey H
JH
The Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. silber@email.chop.edu
Rosenbaum
Paul R
PR
Polsky
Daniel
D
Ross
Richard N
RN
Even-Shoshan
Orit
O
Schwartz
J Sanford
JS
Armstrong
Katrina A
KA
Randall
Thomas C
TC
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006176:Gynecology; D006801:Humans; D008495:Medical Oncology; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality; D018426:SEER Program
D000970:Antineoplastic Agents