Published Jan 2006: Journal of Gynecologic Oncology - "Not Qualified - A Patient's Perspective" author: Sandi Pniauskas

DOI information: 10.1016/j.ygyno.2005.11.045

http://dx.doi.org/10.1016/j.ygyno.2005.11.045


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Letter to the Editor
Published: The Journal of Gynecologic Oncology January 18th, 2006

Not qualified—a patient's perspective

Sandi PniauskasCorresponding Author Contact Information, E-mail sandipn@sympatico.ca

117 Glen Hill Drive, Whitby, Ontario, Canada L1N 6Z8

Received 31 August 2005. Available online 18 January 2006.


Article Outline

References



Wednesday, August 31, 2005

Let me take this proactive approach in once again advocating on behalf of women with ovarian cancer, their families and caretakers. Furthermore, please allow me to emphasize that, as a consumer, I appreciate and understand the wider ‘picture’. however, I do not accept the status quo. As a short recap, I offer my observations as an ‘informed’ (as opposed to expert) ovarian cancer survivor of 6 years. Prior to the publication of Who should operate on patients with ovarian cancer? An evidence-based review [1], I was in discussion with a number of agencies bringing attention to the lack of current information within certain Canadian databases. I was advised that only MDs could request a review, which prompted my correspondence, as follows:

Ovarian cancer has the highest mortality rate of not only all gynecologic cancers, but all female-specific cancers. There is no screening test, and prophylactic surgery is the recommendation for those at high risk (breast/salpingo-oophorectomy). Ignorance of the facts regarding ovarian cancer, including relative risk factors, is due to our lack of comprehensive up-to-date data collection and transparency in its education/publication.

In the past two decades, there has been no improvement in overall survival rates in ovarian cancer. Improvement has been noted only in the area of median survival rates and to some degree a lessening of treatment related side effects. Emphasis on QOL is a new phenomenon in research, but, in my opinion, results are understated. So, having said this, the paper as below was published August 26, 2005 with a specific focus on the surgical management of ovarian cancer. Surgical management is one of the key factors, albeit not the only one, in improved survival rates in patients with advanced stage ovarian cancer as well as reduced recurrence rates in early stages.

In May 2005 and relevant to the discussion at hand is the published paper Development of ovarian cancer surgery quality indications using a modified Delphi approach [2] authored in part by the Surgical Oncology Program, Cancer Care Ontario. The follow-up management is a key and important factor that has not been addressed. This refers to follow-up management of pre/peri/post-menopausal women with ovarian cancer. To date, there are no guidelines. The question is, who should operate on ovarian cancer patients? The study presents no absolute recommendations, and, therefore, we wait. However, as published May 17, 2005, SEER database was used to analyze follow-up times specific to a number of cancers and should also be an obvious important criteria based, in part, on the study published below.

The threshold year of statistical cure for ovarian cancer was 10.4 years. [3].

So, a number of observations if you will, indicating some interesting and poignant comments:

“Our review followed the methodology established by the 2001 U.S. Preventative Services Task Force (USPSTF) and Canadian Task Force (CTF) guidelines [14,15]. (reference 15 refers to Canadian Task Force on Periodic Health Exam; Ottawa, Canada Communication Group; 1994).”

“No evidenced-based guidelines linking surgical specialty with ovarian cancer outcomes were found within the Cochrane database.”

“The results of Eisenkop et al. (1992) demonstrated the greatest influence of surgical specialty on median survival; 35 months for those operated on by GO (gynecologic oncologist) compared to 17 months for those operated on by ‘other’ surgeons.”

“Mayer et al., which was graded as fair (e.g. level of evidence), found that patients (early-stage) operated on by GO had a 24% improvement in 5-year overall survival (P < 0.05).

In conclusion, with the exception of Cochrane, I am unable to request a comprehensive analysis on ovarian cancer. I would however advise that there is an urgency to do so.

References

[1] K.C. Giede, K. Kieser, J. Dodge and B. Rosen, Who should operate on patients with ovarian cancer? An evidence-based review, Gynecol Oncol, University of Toronto, Canada (2005 (Aug 26)).

[2] A. Gagliardi, M. Fung Kee Fung, B. Langer, H. Stern and A.D. Brown, Development of ovarian cancer surgery quality indicators using a modified Delphi approach, Gynecol. Oncol. 97 (2005), pp. 446–456. Abstract | Full Text + Links | PDF (210 K)

[3] P. Tai, E. Yu, G. Cserni, G. Vlastos, M. Royce, I. Kunkler and V. Vinh-Hung, Minimum follow-up time required for the estimation of statistical cure of cancer patients: verification using data from 42 cancer sites in the SEER database, BMC Cancer 5 (2005), p. 48.


Corresponding Author Contact InformationFax: +1 905 666 0188.

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