title: Variations in institutional infrastructure, physician specialization and experience, and outcome in ovarian cancer: a systematic review.
abstract: OBJECTIVE
  Ovarian cancer outcome varies among different institutions, regions, and countries. This systematic review summarizes the available data evaluating the impact of different physician and hospital characteristics on outcome in ovarian cancer patients.
  
  
  METHODS
  A MEDLINE database search for pertinent publications was conducted and reference lists of each relevant article were screened. Experts in the field were contacted. Selected studies assessed the relationship between physician and/or hospital specialty or volume and at least one of the outcomes of interest. The primary outcome was survival. Additional parameters included surgical outcome (debulking), completeness of staging, and quality of chemotherapy. The authors independently reviewed each article and applied the inclusion/exclusion criteria. The quality of each study was assessed by focusing on strategies to control for important prognostic factors.
  
  
  RESULTS
  Forty-four articles met inclusion criteria. Discipline and sub-specialization of the primary treating physician were identified as the most important variable associated with superior outcome. Evidence showing a beneficial impact of institutional factors was weaker, but followed the same trend. Hospital volume was hardly related to any outcome parameter.
  
  
  CONCLUSIONS
  The limited evidence available showed considerable heterogeneity and has to be interpreted cautiously. Better utilization of knowledge about institutional factors and well-established board certifications may improve outcome in ovarian cancer. Patients and primary-care physicians should select gynecologic oncologists for primary treatment in countries with established sub-specialty training. Policymakers, insurance companies, and lay organizations should support development of respective programs.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Klinik (HSK), Ludwig-Erhard-Str. 100, D-65199 Wiesbaden, Germany. Prof.duBois@googlemail.com
authors.forename: Andreas
authors.initials: A
authors.lastname: du Bois
authors.forename: Justine
authors.initials: J
authors.lastname: Rochon
authors.forename: Jacobus
authors.initials: J
authors.lastname: Pfisterer
authors.forename: William J
authors.initials: WJ
authors.lastname: Hoskins
mesh_terms: D005260:Female; D006176:Gynecology; D006761:Hospitals; D006801:Humans; D008495:Medical Oncology; D008511:Medicine; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D013038:Specialization