Highlights
- •Gynecologic oncologist surgeons were associated with increased odds of initiating adjuvant chemotherapy.
- •Gynecologic oncologist surgeons were associated with greater odds of a gynecologic oncologist chemotherapy provider.
- •Gynecologic oncologist adjuvant chemotherapy providers were associated with decreased time from surgery-to-chemotherapy.
- •Rural and urban women traveled farther to receive chemotherapy care with gynecologic oncologist.
- •Rural women (versus urban) had a gynecologic oncologist involved in their adjuvant chemotherapy less and traveled farther.
Abstract
Objective
We aim to evaluate the impact gynecologic oncologists have on ovarian cancer adjuvant
chemotherapy care from their role as surgeons recommending adjuvant chemotherapy care
and their role as adjuvant chemotherapy providers while considering rural-urban differences.
Methods
Multivariable adjusted logistic regressions and Cox proportional hazards models were
developed using a population-based, retrospective cohort of stage II-IV and unknown
stage ovarian cancer patients diagnosed in Iowa, Kansas, and Missouri in 2010–2012
whose medical records were abstracted in 2017–2018.
Results
Gynecologic oncologist surgeons (versus other type of surgeon) were associated with
increased odds of adjuvant chemotherapy initiation (adjusted odds ratio (OR) 2.18;
95% confidence interval (CI) 1.10–4.33) and having a gynecologic oncologist adjuvant
chemotherapy provider (OR 10.0; 95% CI 4.58–21.8). Independent of type of surgeon,
rural patients were less likely to have a gynecologic oncologist chemotherapy provider
(OR 0.52; 95% CI 0.30–0.91). Gynecologic oncologist adjuvant chemotherapy providers
(versus other providers) were associated with decreased surgery-to-chemotherapy time
(rural: 6 days; urban: 8 days) and increased distance to chemotherapy (rural: 22 miles;
urban: 11 miles). Rural women (versus urban) traveled 38 miles farther when their
chemotherapy provider was a gynecologic oncologist and 27 miles farther when it was
not.
Conclusion
Gynecologic oncologist surgeons may impact adjuvant chemotherapy initiation. Gynecologic
oncologists serving as adjuvant chemotherapy providers were associated with some care
benefits, such as reduced time from surgery-to-chemotherapy, and some care barriers,
such as travel distance. The barriers and benefits of having a gynecologic oncologist
involved in adjuvant chemotherapy care, including rural-urban differences, warrant
further research in other populations.
Keywords
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Article info
Publication history
Published online: November 11, 2021
Accepted:
November 3,
2021
Received in revised form:
October 29,
2021
Received:
January 31,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
ScienceDirect
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- Defining the essential role of the gynecologic oncologist in rural ovarian cancer care deliveryGynecologic OncologyVol. 164Issue 1
- PreviewIn 2022, the standard of care in the United States for patients with advanced ovarian cancer includes an assessment by a gynecologic oncologist, primarily for the purpose of determining whether patients are candidates for upfront cytoreductive surgery, or should first be triaged to neoadjuvant chemotherapy [1]. This recommendation stems from robust data that clinical outcomes are optimal when cancer-specific surgery for ovarian cancer is performed by gynecologic oncologists in high-volume institutions.
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