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Does Ovarian Cancer Treatment and Survival Differ by the Specialty Providing Chemotherapy?

Jeffrey H. Silber, Paul R. Rosenbaum, Daniel Polsky, Richard N. Ross, Orit Even-Shoshan, J. Sanford Schwartz, Katrina A. Armstrong, Thomas C. Randall

From the Center for Outcomes Research, The Children's Hospital of Philadelphia; Department of Pediatrics, Division of Pediatric Oncology and Department of Anesthesiology and Critical Care, Division of General Internal Medicine, and Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Pennsylvania School of Medicine; The Leonard Davis Institute of Health Economics, the University of Pennsylvania; and the Department of Statistics, The Wharton School, Philadelphia, PA

Address reprint requests to Jeffrey H. Silber, MD, PhD, The Center for Outcomes Research, The Children's Hospital of Philadelphia, 3535 Market St, Ste 1029, Philadelphia, PA 19104; e-mail: silber{at}email.chop.edu

Purpose Chemotherapy for ovarian cancer is usually administered by medical oncologists (MOs) or gynecologic oncologists (GOs). GOs perform a broad spectrum of surgical and medical activities while managing a limited number of diseases; MOs specialize in the administration of chemotherapy but manage a broad array of diseases. We asked whether survival, treatment, and toxicity differed according to the type of specialist providing the chemotherapy after surgery.

Patients and Methods Using Surveillance, Epidemiology, and End Results (SEER) -Medicare data for patients 65 years old from 1991 through 2001 from eight SEER sites, we identified 344 patients with ovarian cancer who were treated with chemotherapy by a GO after surgery. Using optimal matching and propensity scores based on 36 characteristics, we matched these patients to 344 similar patients who were operated on and staged by the same type of surgeon but who received chemotherapy from an MO.

Results MOs administered chemotherapy over more weeks than did the GOs (16.5 v 12.1 weeks, respectively; P < .0023), and MO patients had substantially more weeks that included chemotherapy-associated adverse events than GO patients (16.2 v 8.9 weeks, respectively; P < .0001). However, there was no difference in 5-year survival rate between the GO and MO groups (35% v 34%, respectively; P = .45).

Conclusion GO- and MO-treated patients who were closely matched on prognostic characteristics experienced very different rates of chemotherapy-associated adverse events and very different chemotherapy treatment styles by specialty type; however, their survival was virtually identical.

Supported by Grant No. R01-CA095664 (J.H.S.) from the National Cancer Institute and Grant No. SES-0345113 (P.R.R.) from the National Science Foundation.

Presented at the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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