Is It Time to Centralize Ovarian Cancer Care in the United States?
OBJECTIVE
The purpose of this article was to broadly review the most up-to-date information pertaining to the centralization of ovarian cancer care in the United States (US) and worldwide.


METHODS
Much of the present literature pertaining to disparities in, and centralization of, ovarian cancer care in the US and internationally was reviewed, and specifically included original research and review articles.


RESULTS
Data show improved optimal debulking rates, National Comprehensive Cancer Network (NCCN) guideline adherence, and overall survival rates in higher-volume, more specialized hospitals, and amongst higher-volume providers.


CONCLUSIONS
Patients with invasive epithelial ovarian cancer, especially those with higher stages (III and IV), are better served by centralized care in high-volume hospitals and by high-volume physicians, who adhere to NCCN guidelines wherever possible. More research is needed to determine the policy changes that can increase NCCN guideline adherence in low-volume hospitals and low-provider caseload scenarios. Policy and future research should be aimed at increasing patient access, either directly or indirectly, to high-volume hospital and high-volume providers, especially amongst Medicare, lower socioeconomic status, and minority patients.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Renee A
RA
Cowan
Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
Roisin E
RE
O'Cearbhaill
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
Ginger J
GJ
Gardner
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
Douglas A
DA
Levine
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Kara Long
KL
Roche
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
Yukio
Y
Sonoda
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Oliver
O
Zivanovic
Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Weill Cornell Medical College, New York, NY, USA.
William P
WP
Tew
Weill Cornell Medical College, New York, NY, USA.|Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Evis
E
Sala
Weill Cornell Medical College, New York, NY, USA.|Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Yulia
Y
Lakhman
Weill Cornell Medical College, New York, NY, USA.|Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Hebert A
HA
Vargas Alvarez
Weill Cornell Medical College, New York, NY, USA.|Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Debra M
DM
Sarasohn
Weill Cornell Medical College, New York, NY, USA.|Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Svetlana
S
Mironov
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. abu-rusn@mskcc.org.|Weill Cornell Medical College, New York, NY, USA. abu-rusn@mskcc.org.
Nadeem R
NR
Abu-Rustum
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. gynbreast@mskcc.org.|Weill Cornell Medical College, New York, NY, USA. gynbreast@mskcc.org.
Dennis S
DS
Chi
D002173:Cancer Care Facilities / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D010051:Ovarian Neoplasms / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011379:Prognosis; D014481:United States