Adherence to practice guidelines is associated with reduced referral times for patients with ovarian cancer.

Adherence to practice guidelines is associated with reduced referral times for patients with ovarian cancer.

Am J Obstet Gynecol. 2018 Jan 15;:

Authors: Boac BM, Xiong Y, Apte SM, Wenham RM, Shahzad MM, Munroe DG, Lancaster JM, Chon HS

Abstract
BACKGROUND: Patients with ovarian cancer tend to receive the highest quality of care at high-volume cancer centers with gynecologic oncologists. However, the care that they receive prior to gynecologic oncology consult has not been examined. We investigated the quantity and quality of care given to patients with ovarian cancer before being seen by a gynecologic oncologist.
OBJECTIVES: We evaluated the variability, quantity, and quality of diagnostic testing and physician-referral patterns prior to consultation with a gynecologic oncologist, in women with suspicious pelvic masses seen on imaging.
STUDY DESIGN: A chart review was performed on patients treated for ovarian cancer at a single institution from 2001 to 2014. We evaluated their workup in 4 categories, drawn from National Comprehensive Care Network guidelines: provider visits, abdominal/pelvic imaging, chest imaging, and tumor markers. Workup was classified as guideline adherent or guideline nonadherent.
RESULTS: We identified 335 cases that met our criteria. In the provider visit category, 83.9% of patients received guideline adherent workup; 77% in the abdominal/pelvic imaging, 98.2% in the chest imaging, and 95.2% in the tumor marker categories. Each patient's workup was assessed as a compilation of the 4 categories, yielding 65.7% patients as having received an adherent workup and 34.3% of workup as nonadherent to guidelines. The timeframe to see a gynecologic oncologist for patients with guideline-adherent workup was significantly shorter than for those whose workup was nonadherant (20 versus 86 days, P < .001). A suspicious pelvic mass was identified by obstetrics/gynecology in only 23.9% of patients; 42.7% of patients did not have tumor marker testing before gynecologic oncologist consult. When an obstetrics/gynecology specialist discovered the suspicious pelvic mass, the remaining workup was more likely to be guideline adherent prior to gynecologic oncologist referral than when initial imaging was not ordered by an obstetrics/gynecology specialist (P = .18). Survival was not significantly different (P = .103).
CONCLUSIONS: With guideline-adherent workup, including tumor marker testing, gynecologic oncologist referral times can be shortened, minimizing cost inefficiencies and delays that can compromise the effectiveness of downstream care for patients with ovarian cancer. Guidelines should be disseminated beyond the obstetrics/gynecology field.

PMID: 29353030 [PubMed - as supplied by publisher]

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