title: The optimal organization of gynecologic oncology services: a systematic review.
abstract: BACKGROUND
  A system-level organizational guideline for gynecologic oncology was identified by a provincial cancer agency as a key priority based on input from stakeholders, data showing more limited availability of multidisciplinary or specialist care in lower-volume than in higher-volume hospitals in the relevant jurisdiction, and variable rates of staging for ovarian and endometrial cancer patients.
  
  
  METHODS
  A systematic review assessed the relationship of the organization of gynecologic oncology services with patient survival and surgical outcomes. The electronic databases medline and embase (ovid: 1996 through 9 January 2015) were searched using terms related to gynecologic malignancies combined with organization of services, patterns of care, and various facility and physician characteristics. Outcomes of interest included overall or disease-specific survival, short-term survival, adequate staging, and degree of cytoreduction or optimal cytoreduction (or both) for ovarian cancer patients by hospital or physician type, and rate of discrepancy in initial diagnoses and intraoperative consultation between non-specialist pathologists and gyne-oncology-specialist pathologists.
  
  
  RESULTS
  One systematic review and sixteen additional primary studies met the inclusion criteria. The evidence base as a whole was judged to be of lower quality; however, a trend toward improved outcomes with centralization of gynecologic oncology was found, particularly with respect to the gynecologic oncology care of patients with advanced-stage ovarian cancer.
  
  
  CONCLUSIONS
  Improvements in outcomes with centralization of gynecologic oncology services can be attributed to a number of factors, including access to specialist care and multidisciplinary team management. Findings of this systematic review should be used with caution because of the limitations of the evidence base; however, an expert consensus process made it possible to create recommendations for implementation.
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON;
authors: M
authors: M
authors: Fung-Kee-Fung
authors: Program in Evidence-Based Care, Cancer Care Ontario, and Department of Oncology, McMaster University, Hamilton, ON;
authors: E B
authors: EB
authors: Kennedy
authors: Southeastern Ontario Health Sciences Centre, Palliative Care Medicine Program, Kingston, ON;
authors: J
authors: J
authors: Biagi
authors: Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON;
authors: T
authors: T
authors: Colgan
authors: London Regional Cancer Program, London, ON;
authors: D
authors: D
authors: D'Souza
authors: Juravinski Cancer Centre and McMaster University, Hamilton, ON;
authors: L M
authors: LM
authors: Elit
authors: Surgical Oncology Program, Cancer Care Ontario, Toronto, ON;
authors: A
authors: A
authors: Hunter
authors: Surgical Oncology Program, Cancer Care Ontario, Toronto, ON;
authors: J
authors: J
authors: Irish
authors: Surgical Oncology Program, Cancer Care Ontario, Toronto, ON;
authors: R
authors: R
authors: McLeod
authors: Department of Gynecology-Oncology, Princess Margaret Hospital, Toronto, ON.
authors: B
authors: B
authors: Rosen
keywords: Organization; gynecologic oncology; systematic reviews