title: A triage assessment strategy for the management of women with endometrial cancer.
abstract: OBJECTIVE
  This study examined a risk-factor-based assignment to either a subspecialist or a general gynaecologist for the management of women with endometrial cancer.
  
  
  METHODS
  At diagnosis, all women with a diagnosis of endometrial cancer in four community hospitals were referred to a central cancer centre and stratified into low- and high-risk groups. Risk stratification was based primarily on central pathology review, with low-risk disease defined as grade 1, clinical stage 1. Women with low-risk disease were triaged back to the referring gynaecologist for surgery. Women with high-risk disease were managed at the cancer centre. The main outcome measures included risk status and pathology review, treatment and treatment location, and acceptability to patients and gynaecologists.
  
  
  RESULTS
  Seventy-three women participated in this pilot study between November 2009 and 2010. Risk stratification was performed in all women: 37 were classified as high risk and 36 as low risk. Ninety-seven percent of women with high-risk disease were managed at the cancer centre, and 83% of these women underwent surgical staging compared with 8% for women with low-risk disease. This approach was acceptable to both patients and gynaecologists.
  
  
  CONCLUSIONS
  This structured pattern of care for women with endometrial cancer resulted in a shift in management, with more women managed in accordance with oncologic guidelines, meaning that women at high risk for metastases had a lymphadenectomy performed.
authors: Division of Gynaecologic Oncology, University Health Network, University of Toronto, Toronto ON.
authors: Luc R C W
authors: LRCW
authors: van Lonkhuijzen
authors: Division of Gynaecologic Oncology, University Health Network, University of Toronto, Toronto ON.
authors: Barry P
authors: BP
authors: Rosen
authors: Division of Gynaecologic Oncology, University Health Network, University of Toronto, Toronto ON.
authors: Stephanie
authors: S
authors: Bertin
authors: Department of Pathology, University Health Network, University of Toronto, Toronto ON.
authors: Blaise
authors: B
authors: Clarke
authors: Division of Gynaecologic Oncology, University Health Network, University of Toronto, Toronto ON.
authors: Marcus Q
authors: MQ
authors: Bernardini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016889:Endometrial Neoplasms / Q000145:classification* / Q000473:pathology / Q000601:surgery; D005260:Female; D006176:Gynecology / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology / Q000517:prevention & control; D009367:Neoplasm Staging; D010865:Pilot Projects; D018570:Risk Assessment / Q000379:methods
keywords: cohort study; endometrial cancer; pathology review; pattern of care; risk stratification; treatment