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What Is the Best Treatment Model for Gynecologic Cancers? Does Centralization Help?

  • Claes Göran Tropé
  • Torbjørn Paulsen
  • Ayesha Saqib
  • Craig Underhill
Chapter

Abstract

Arguments for centralization of EOC treatment: There is considerable debate about whether specialized care has an effect on with the outcome of advanced (stages III–IV) epithelial ovarian cancer (EOC). It is known that the quality of surgery is one of the most important factors affecting the outcome of women with advanced EOC. We have reviewed the European population-based literature, focusing especially on studies published in the last 10 years, and have found that the evidence shows advantages for patients who undergo surgery performed by gynecologic oncologists over general gynecologists and general surgeons in terms of quality of life, morbidity, and survival. Despite this, population-based studies in Europe show that less than 50 % of patients with advanced EOC have their surgery performed by a gynecologic oncologist, and the debate about the benefits of advanced EOC centralization has continued. It is of great importance that EOC be centralized to centers with sufficiently skilled surgeons and the necessary organization to appropriately handle advanced EOC patients. This requires national health systems to secure sufficient education and training for all medical staff involved. Gynecologic cancers make up the second most common cancer among women. Five major gynecologic malignancies include cervical, ovarian, uterine vaginal, and vulvar cancers. All would agree that their management requires a multidisciplinary approach encompassing combinations of surgery, chemotherapy, and radiation treatment and also needing the help of psychologists, social workers, specialized nurses, and others. It has been claimed that centralization of gynecologic cancer improves outcome, but robust evidence is lacking. Most of the available evidence addresses ovarian cancer in developed countries and contains no information on the role of satellite centers or of other care models which can match the outcomes of centralized services. In fact for all gynecologic malignancy, the treatment site does not affect overall survival. All agree that accurate and complete surgical staging is associated with prolonged survival rates in women with early ovarian cancer and that optimal debulking improves progression-free and overall survival rates in advanced disease. But ovarian cancer is but one part of the spectrum of gynecologic malignancy and, indeed, given the epidemic of endometrial cancer due to obesity, which could engulf specialized units, a relatively less common one than previously. The data on surgical outcomes and their importance are still controversial and relate only to ovarian cancers. There are very few studies addressing outcomes in the other more common gynecologic malignancies including cervical and endometrial. It is impossible to prove that centralization is necessary as most of the published evidence is based on retrospective observational studies and therefore is at high risk of bias. To date no randomized trials have been undertaken to confirm this hypothesis

Keywords

Endometrial Cancer Epithelial Ovarian Cancer Cytoreductive Surgery Gynecologic Oncologist Gynecologic Malignancy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We wish to thank Ms. Trudy Perdrix-Thoma for her assistance in editing the chapter and Mrs. Gry Seppola for technical assistance. We also gratefully acknowledge the financial support from the Inger and John Fredriksen Foundation for Ovarian Cancer Research.

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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Claes Göran Tropé
    • 1
    • 2
  • Torbjørn Paulsen
    • 3
  • Ayesha Saqib
    • 4
  • Craig Underhill
    • 5
  1. 1.Department of Gynaecological OncologyOslo University Hospital, The Norwegian Radium HospitalOsloNorway
  2. 2.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Department of Gynaecological OncologyOslo University Hospital, The Norwegian Radium HospitalOsloNorway
  4. 4.Medical OncologyAlbury Base HospitalMelbourneAustralia
  5. 5.Border Medical OncologyWodongaAustralia

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