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Comparative Study
. 2021 Oct 1;44(10):544-551.
doi: 10.1097/COC.0000000000000860.

Impact of Surgeon Type and Rurality on Treatment and Survival of Ovarian Cancer Patients

Kristin S Weeks  1   2 , Charles F Lynch  2   3 , Michele M West  3 , Ryan M Carnahan  2 , Michael A O'Rorke  2 , Jacob J Oleson  4 , Megan E McDonald  5 , Mary E Charlton  2   3
Affiliations
Comparative Study

Impact of Surgeon Type and Rurality on Treatment and Survival of Ovarian Cancer Patients

Kristin S Weeks et al. Am J Clin Oncol. .

Abstract

Background: National Comprehensive Cancer Network guidelines recommend ovarian cancer patients receive cancer-directed surgery from a gynecologic oncologist surgeon. We aimed to determine if rurality impacts type of surgeon and estimate if the interaction between rurality and type of surgeon impacts cytoreductive surgery, chemotherapy initiation, and survival.

Methods: Our population-based cohort of Iowan (N=675) ovarian cancer patients included women diagnosed with histologically confirmed stages IB-IV cancer in 2010 to 2016 at the ages of 18 to 89 years old and who received cancer-directed surgery in Iowa. Multivariable logistic regression analysis and Cox proportional hazards models were used.

Results: Rural (vs. urban) patients were less likely to receive surgery from a gynecologic oncologist (adjusted odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.30-0.78). Rural patients with a gynecologic oncologist (vs. nongynecologic oncologist) surgeon were more likely to receive cytoreduction (OR: 2.84; 95% CI: 1.31-6.14) and chemotherapy (OR: 4.22; 95% CI: 1.82-9.78). Gynecologic oncologist-provided surgery conferred a 3-year cause-specific survival advantage among rural patients (adjusted hazard ratio: 0.57; 95% CI: 0.33-0.97) and disadvantage among urban patients (hazard ratio: 1.77; 95% CI: 1.02-3.06) in the model without treatment covariates. Significance dissipated in models with treatment variables.

Discussion: The variation in the gynecologic oncologist survival advantage may be because of treatment, referral, volume, or nongynecologic oncologist surgeons' specialty difference by rurality. This is the first study to investigate the ovarian cancer survival advantage of having a gynecologic oncologist surgeon by rurality.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Image 1.
Image 1.
3-Year Cause-Specific Survival Probability by Rurality and Surgeon Type (N=675) This image shows the overall patterns of cause-specific survival estimates by the interaction between rurality and type of surgeon. The Kaplan-Meier estimator method was used and comparisons between the levels of the interaction were evaluated using a log-rank test (p-value=0.098).
See this image and copyright information in PMC

References

    1. National Academies of Sciences E, and Medicine. 2016. Ovarian cancers: Evolving paradigms in research and care. Washington, DC: The National Academies Press. doi: 10.17226/21841. - DOI - PubMed
    1. National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Breast and Ovarian. Version I. Fort Washington PN. 2017.
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