National survey of ovarian carcinoma part V. The impact of physician's specialty on patients' survival

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Abstract
Background. Data analysis of the recent National Survey of Ovarian Carcinoma revealed significant differences in patterns of care among various physician specialists. The goal of this study was to determine if different care patterns led to differences in patient survival. Methods. Data were collected from 25 consecutive patients with ovarian cancer diagnosed in 1983 and 1988 from 1230 hospitals with cancer programs across the United States. Results. A total of 12,316 patients from 904 hospitals were registered, of whom 20.8% were cared for by gynecologic oncologists (GYO), 45.0% by obstetrician‐gynecologists (OBG), and 21.1% by general surgeons (GS). GYO preferred the upper‐lower midline incision in 44.1% of patients, whereas both OBG and GS chose the low midline approach in 44–45%. GYO performed more hysterectomies, oophorectomies, omentectomies, and lymph node and peritoneal biopsies than did other specialists. Although the rates of surgery of the small intestine were comparable between GYO and GS, the latter performed significantly more colostomies and resections of the large intestine. The optimal debulking rates were: GYO, 42–45%; OBG, 40–44%; and GS 25%. There was no significant survival difference between patients cared for by GYO and those cared for by OBG for all stage divisions. However, with the exception of patients with Stage I disease, patients cared for by GS had significantly reduced survival than did those cared for by GYO and OBG (P < 0.004). Conclusion. Efforts must be made to ensure that more patients with ovarian cancer are cared for by physicians in the appropriate specialties.