title: Quality of care in advanced ovarian cancer: the importance of provider specialty.
abstract: BACKGROUND
  One of the cornerstones of ovarian cancer therapy is cytoreductive surgery, which can be performed by surgeons with different specialty training. We examined whether surgeon specialty impacts quality of life (as proxied by presence of ostomy) and overall survival for women with advanced ovarian cancer.
  
  
  METHODS
  Stage IIIC/IV ovarian cancer patients were identified using 4 state cancer registries: California, Washington, New York, and Florida and linked records to the corresponding inpatient-hospital discharge file, AMA Masterfile, and 2000 U.S. Census SF4 File. Predictors of receipt of care by a general surgeon and creation of fecal ostomy were analyzed. Multivariate modeling was performed to assess the association of hospital volume (low volume (LV) [0-4 cases], middle volume (MV) [5-9], high volume (HV) [10-19], and very high volume (VHV) [20+]) and surgeon specialty training (gynecologic oncologists/gynecologists, general surgeons, and other specialty) on survival.
  
  
  RESULTS
  We identified 31,897 Stage IIIC/IV patients; mean age was 64 years. Treatment of patients by a general surgeon was predicted by LV, rural patient residence, poverty, and high level of comorbidity. Patients had lower hazard of death when treated in higher volume hospitals as compared to LV [VHV hazard ratio (HR)=0.79, P<.0001; HV HR=0.89, P<0.001]. Patients treated by a general surgeon had higher likelihood of an ostomy (OR=4.46, P<.0001) and hazard of death (HR=1.63, P<.0001) compared to gynecologic oncologist/gynecologist.
  
  
  CONCLUSIONS
  Advanced stage ovarian cancer patients have better survival when treated by gynecologic oncology/gynecology trained surgeons. Data suggest that referral to these specialists may optimize surgical debulking and minimize the creation of a fecal ostomy.
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-6904, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Mercado
authors.forename: David
authors.initials: D
authors.lastname: Zingmond
authors.forename: Beth Y
authors.initials: BY
authors.lastname: Karlan
authors.forename: Evan
authors.initials: E
authors.lastname: Sekaris
authors.forename: Jenny
authors.initials: J
authors.lastname: Gross
authors.forename: Melinda
authors.initials: M
authors.lastname: Maggard-Gibbons
authors.forename: James S
authors.initials: JS
authors.lastname: Tomlinson
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
mesh_terms: D015331:Cohort Studies; D003125:Colostomy / Q000379:methods / Q000592:standards; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011787:Quality of Health Care; D011788:Quality of Life; D012042:Registries; D012959:Socioeconomic Factors; D013043:Specialties, Surgical / Q000592:standards*; D015996:Survival Rate; D016896:Treatment Outcome