Improving quality and decreasing cost in gynecologic oncology care. Society of gynecologic oncology recommendations for clinical practice.
OBJECTIVE
To identify potential cost savings in gynecologic oncology care without sacrificing quality.


METHODS
Members of the Clinical Practice Committee of the Society of Gynecologic Oncology were asked to review current practice patterns in gynecologic oncology and assess the potential for cost savings founded on evidence-based medicine and current guidelines.


RESULTS
Five clinical practices were identified including the following: vaginal cytology for endometrial cancer survivors; colposcopy for low grade cytologic abnormalities for cervical cancer survivors; routine imaging studies for gynecologic cancer survivors; screening for ovarian cancer with serum biomarkers and ultrasound; and improving palliative care for gynecologic cancer patients. Review of the published literature and guidelines were performed to make evidence-based recommendations for cost effective quality gynecologic oncology care.


CONCLUSIONS
• Do not perform Pap tests of the vaginal cuff in patients with a history of endometrial cancer. • Do not perform colposcopy for low grade Pap tests in women with a history of cervical cancer. • Avoid routine imaging for cancer surveillance in asymptomatic women with gynecologic cancer, specifically ovarian, endometrial, cervical, vulvar and vaginal cancer. • Do not screen women at low risk for ovarian cancer with ultrasound or CA-125 or other biomarkers. • Do not delay basic level palliative care for women with advanced or relapsed gynecologic cancer, do refer to a palliative care specialist when needed, and avoid unnecessary treatments at life's end.
Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: bobbie.rimel@cshs.org.
B J
BJ
Rimel
Columbia University Medical Center, 630 W 168th St., New York, NY, USA.
William M
WM
Burke
Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
Robert V
RV
Higgins
Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27705, USA.
Paula S
PS
Lee
Miami Valley Hospital, 1 Wyoming St., Dayton, OH 45409, USA.
Christopher V
CV
Lutman
University of Louisville, 2301 S 3rd St., Louisville, KY 40292, USA.
Lynn
L
Parker
D000328:Adult; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D006176:Gynecology / Q000191:economics* / Q000379:methods / Q000592:standards*; D006801:Humans; D008403:Mass Screening; D008495:Medical Oncology / Q000191:economics* / Q000379:methods / Q000592:standards*; D010166:Palliative Care; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012955:Societies, Medical
Cost containment