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Reorganization of hospital services benefited survival of gynecological cancer patients
Crawford R. BJOG. 2012;119:160-165.
Gynecological cancer survival rates improved in eastern England after the reorganization of services and multidisciplinary teams, according to study results published in BJOG: An International Journal of Obstetrics and Gynaecology.
After the implementation of good-practice guidance on commissioning cancer services for gynecology in 1999 — which called for a reorganization of services, working in multidisciplinary teams and a concentration of surgical expertise in centers — the British Department of Health published referral guidance for primary care for symptoms that were suggestive of cancer.
Hospital providers were expected to respond to the referral in a timely fashion, with a target of 2 weeks between the date of referral and the first appointment, to improve outcomes and address the disparity in access to diagnosis and treatment.
Women diagnosed between 1996 and 2003 with invasive gynecological cancer at the nine main NHS hospitals in the Anglia Cancer Network were identified by the Eastern Cancer Registration and Information Centre, totaling 3,406 cases. Sixty percent of these cases had known stage and grade, and to guarantee that any comparisons were case-matched, only these were selected for the subsequent survival analysis.
Researchers found that the survival of cancers diagnosed between 1997 and 1999 was approximately identical to the survival of cancers diagnosed in the baseline year, 1996. However, following good-practice implementation, survival of cases diagnosed between 2000 and 2003 increased significantly with an overall improvement of 17%. The study demonstrated that uterine cancer improved by 9.5%, to 83%, and ovarian cancer improved by 45%, to nearly 40%, when compared with cancers diagnosed in the 4 earlier years.
“In addition to the minor year-on-year improvements, there was a significant stepwise improvement in survival in 2000, following the major reorganization in the region,” Robin Crawford, MD, consultant gynecological oncologist, Addenbrooke’s Hospital, Cambridge, said in a press release. “Centralizing services and working in multidisciplinary teams has been shown to improve patient care significantly and, most importantly, survival rates.”
Disclosure: Dr. Crawford reports no relevant financial disclosures.
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