title: An organizational guideline for gynecologic oncology services.
abstract: OBJECTIVE
  Documented variations in practice compelled the need to establish a network that would facilitate the flow of patients through the care continuum of a provincial health care system in accordance with best practices. Therefore, a guideline was developed to provide recommendations for the optimal organization of gynecologic oncology services in this higher resource location to improve access to multidisciplinary care and appropriate treatment.
  
  
  METHODS
  A systematic review was conducted of Web sites of international guideline developers, relevant cancer agencies, and Medline and EMBASE from 1996 to 2011 using search terms related to gynecologic malignancies, combined with organization of services, patterns of care, and various facility and physician characteristics. The results of the review were combined with expert consensus and stakeholder consultation to develop a gynecologic oncology services organizational guideline.
  
  
  RESULTS
  The evidence review yielded a lower quality evidence base; therefore, recommendations were determined through consensus, including guidance for physician and hospital specialization, and other domains including human and physical resources. Definitive surgical treatment of most invasive cancers by subspecialist gynecologic oncologists is recommended. In addition, it is recommended that these subspecialists provide care within designated gynecologic oncology centers. The recommendations also outline which services, such as radiation therapy, may be provided in other affiliated centers. Multidisciplinary team management is also endorsed.
  
  
  CONCLUSIONS
  These recommendations are intended to allow a collaborative community of practice, supported by formal interorganizational processes, to evolve to facilitate adherence to guidelines and best practices at a system-wide level.
authors.affiliation: *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; †Program in Evidence-Based Care, Cancer Care Ontario and Department of Oncology, McMaster University, Hamilton, Ontario, Canada; ‡Southeastern Ontario Health Sciences Centre, Palliative Care Medicine Program, Kingston, Ontario, Canada; §Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; ∥London Regional Cancer Centre, London, United Kingdom; ¶Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; #Surgical Oncology Program, Cancer Care Ontario, Canada; and **Department of Gynecology-Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Fung-Kee-Fung
authors.forename: Erin B
authors.initials: EB
authors.lastname: Kennedy
authors.forename: Jim
authors.initials: J
authors.lastname: Biagi
authors.forename: Terry
authors.initials: T
authors.lastname: Colgan
authors.forename: David
authors.initials: D
authors.lastname: D'Souza
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Elit
authors.forename: Amber
authors.initials: A
authors.lastname: Hunter
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
authors.forename: Robin
authors.initials: R
authors.lastname: McLeod
authors.forename: Barry
authors.initials: B
authors.lastname: Rosen
mesh_terms: D005260:Female; D005833:Genital Neoplasms, Female / Q000517:prevention & control*; D006801:Humans; D016522:Oncology Service, Hospital / Q000458:organization & administration* / Q000592:standards*; D011379:Prognosis