Efficacy of a regional network for ovarian cancer care.
OBJECTIVE
To study the influence of a regional collaboration in epithelial ovarian cancer care on staging procedures, debulking results, and survival.


METHODS
In an effort to optimize epithelial ovarian cancer treatment, a regional collaboration was introduced in the Netherlands in 2000. Gynecologic oncologists from the university center conducted surgery in community hospitals when ovarian cancer was considered based on the risk of malignancy index or clinical suspicion. The National Cancer Registry registered 1,554 patients with epithelial ovarian cancer diagnosed in 11 participating Dutch hospitals between 1996 and 2010. Surgical procedures were compared during three periods (1996-1999, 2000-2004, and 2005-2009). Log-rank tests compared Kaplan-Meier survival curves of progression-free and overall survival before (1996-2000) and during the start of the collaboration (2001-2005).


RESULTS
Staging was adequate for 139 patients (23.0%) before collaboration, and this proportion increased during the study periods to 32.1% and 62.1% (P<.01), when gynecologic oncologists more often staged cancer in patients (36.7% compared with 54.7% and 80.6%; P<.01). For 1,197 patients with advanced stage disease (stage IIb or greater), the proportion of debulking procedures with an optimal (residual volume less than1 cm) as well as a complete result (no residuals) increased during the 14-year study period from 57.4% to 76.5% (P<.01) and from 24.1% to 43.4% (P<.01), respectively. Survival rates were similar before and during the start of the collaboration. In multivariable analysis, the treatment variables completeness of debulking, chemotherapy, and gynecologic oncologist attendance were independent prognostic factors for overall survival, as were age, stage, and tumor grade.


CONCLUSIONS
After regional collaboration, gynecologic oncologists attended more surgeries and surgical outcomes improved, but progress in survival could not be demonstrated. Regional collaboration improved care for ovarian cancer patients.


METHODS
II.
Department of Obstetrics and Gynecology, Radboud University Medical Centre, Nijmegen, the Netherlands. A.vanAltena@obgyn.umcn.nl
Anne M
AM
van Altena
Petronella A J
PA
van den Akker
Joanne A
JA
de Hullu
Petronella B
PB
Ottevanger
Annet L
AL
Aalders
Rene
R
Gerritse
Martin
M
Happel
Marcel P
MP
Hoekstra
Mark-Jan
MJ
Janssen
Rahul A K
RA
Samlal
Kirsten M W H
KM
Smeets
Marc P M L
MP
Snijders
Maria J
MJ
Vasmel
Jos H A
JH
Vollebergh
Lambertus A L M
LA
Kiemeney
Leon F A G
LF
Massuger
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008495:Medical Oncology; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010053:Ovary / Q000473:pathology; D012041:Regional Medical Programs; D055815:Young Adult