Referral Patterns for Gynecologic Oncology Consultation [29D]

Abstract

INTRODUCTION: Women may experience worse outcomes from gynecologic cancers from delays in timely referral; however, care pathways for these patients are not well described. This study investigates the referral timeline of patients with suspected gynecologic cancers to identify opportunities for improved triage to subspecialist care. METHODS: 50 consecutive patients seen at the Wake Forest Comprehensive Cancer Center for suspected malignancy or hyperplasia/dysplasia were identified. Clinical characteristics, demographics, number and sequence of providers seen for the patient's complaint, as well as time between evaluation, treatment, and referral were abstracted from the medical record. Descriptive statistics and logistic regression analyses were performed. RESULTS: Mean patient age was 58.5 years (SD=15.3). Mean distance traveled for care was 30 miles (SD=25). Disease sites included uterine corpus (n=27, 54%), ovary/fallopian tube/peritoneum (n=9, 18%), vulva (n=6, 12%), uterine cervix (n=5, 10%), and vagina (n=3, 6%). Referrals to gynecologic oncology were initiated by obstetrician-gynecologists (76%), family practitioners (12%), and emergency physicians (4%). 30% (N=15) of patients saw 2+ providers prior to gynecologic oncology referral. Mean interval between first evaluation and referral to gynecologic oncology was 39.3 days (SD=62.8). Mean interval between first evaluation and treatment was 75.9 days (SD=72.9). CONCLUSION: The >5 week interval between initial evaluation and referral to a gynecologic oncologist should be reduced through expeditious recognition of signs and symptoms concerning for malignancy. Additionally, education for non-obstetrician-gynecologists should target reducing the 30% of patients seen by multiple providers before gynecologic oncology evaluation. Factors associated with the highest risk for delays in care remain unclear.