An Italian National Survey on Ovarian Cancer Treatment at first diagnosis. There's None so Deaf as those who will not Hear

Abstract

Objective: Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, crucial prognostic factors are no gross residual disease and centralization of cases. To evaluate the centralization of EOC patients, we report the results of a survey that shows the daily management of EOC patients in Italy. Methods: A 49-items electronic unblinded survey assessing demographics, practice characteristics, current opinions and approach to managing advanced EOC at first diagnosis was sent both to general gynecologists (GG) and gynecologic oncologists (GO). Differences in frequency distribution of answers between gynecologists with different expertise were evaluated using Fisher exact test. Multivariable analyses were performed applying generalized linear models. Results: 84/192 (44%) GG and 108/192 (56%) GO from all Italian regions answered to our survey. GOs declared to perform fertility sparing surgery in early EOC more frequently than GG (p=0.002). GOs can perform a frozen section and have both a gynecopathologist and a dedicated general surgeon. 89% of GOs consider as “optimal debulking” no gross residual disease and 81% achieve this at upfront cytoreduction in more than 40% of patients. Use of neoadjuvant chemotherapy decreases in higher volume centers (p<0.001) while it is lower in the group of GOs than in the GGs group (p<0.001). Conclusions: EOC patients are still treated by GGs. GOs perform more upfront surgery and achieve optimal debulking in a greater percentage of patients than GGs. In Italy an adequate centralization of cases has not yet been achieved, and this may have detrimental effects on the quality of treatment.

Assessment of Hospital Volume in the Surgical Management of Endometrial and Ovarian Cancer: A Polish Population-Based Study

“…The centralization of oncological treatment improves survival with a simultaneous reduction in complications [16]. In Italy, most surgeries for ovarian cancer were performed by general gynecologists, but their oncological results were worse than those of gynecologic oncologists [17]. Recently, similar observations were reported by Jochum et al during the International Gynecologic Cancer Society Congress in New York [18].…”

“…They concluded that high-volume centers are expected to improve the prognosis of ovarian cancer; moreover, adequate management of comorbidities and postoperative complications are expected in high-volume centers. Although centralization of treatment can cause barriers related to long travel, improvements in oncological outcome fully justifies the development of high-volume centers [17,19].…”

Impact of 2 years of COVID‐19 pandemic on ovarian cancer treatment in IRCCS‐AUSL of Reggio Emilia

“…In 2013, the Emilia-Romagna regional audit reported that most of the hospitals that treated EOC patients were low-volume centers and only 45.6% of EOC patients were treated in high-volume centers, where they achieved significantly better survival. [11][12][13][14] A recent Italian national survey on EOC treatment showed that EOC patients are still treated by general gynecologists despite the well-known detrimental effect on survival. 13 Regional data from 2017-2018 showed a wide dispersion of surgeries for EOC patients, 22 hospitals surgically treated at least one case of EOC and 15 hospitals treated fewer than 10 EOC patients/year.…”

“…[11][12][13][14] A recent Italian national survey on EOC treatment showed that EOC patients are still treated by general gynecologists despite the well-known detrimental effect on survival. 13 Regional data from 2017-2018 showed a wide dispersion of surgeries for EOC patients, 22 hospitals surgically treated at least one case of EOC and 15 hospitals treated fewer than 10 EOC patients/year. 14 To ensure adequate care and the best treatment for EOC patients and so guarantee the best prognosis, the Emilia-Romagna Region enacted a regional decree in December 2019 intended to centralize the care of ovarian cancer patients in which it proposed an oncology network based on the hub-and-spoke model.…”

“…Despite irrefutable evidence, most patients are still treated in low‐volume hospitals. In 2013, the Emilia‐Romagna regional audit reported that most of the hospitals that treated EOC patients were low‐volume centers and only 45.6% of EOC patients were treated in high‐volume centers, where they achieved significantly better survival 11–14 . A recent Italian national survey on EOC treatment showed that EOC patients are still treated by general gynecologists despite the well‐known detrimental effect on survival 13 .…”