Why American women are not receiving state-of-the-art gynecologic cancer care.
Department of Gynecologic Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston 77030, USA.
American women are not receiving state-of-the-art gynecologic cancer care. The three most common gynecologic cancers-endometrial, ovarian, and cervical-are
quite uncommon in the United States when compared with other malignancies.
Nevertheless, their importance is clearly out of proportion to their incidence since the annual death rate from ovarian cancer alone is about one third that of breast cancer. And cervical cancer is a very common malignancy of women worldwide.
The major problem accounting for suboptimal treatment of ovarian and
endometrial cancers in the United States is incomplete surgical staging performed
by nongynecologic oncologists.
In the case of cervical cancer treatment,
suboptimal care is attributable to specialty territoriality and the lack of randomized
Factors influencing substandard gynecologic cancer for American women
include the following:
(1) the unregulated nature of the American health care
(2) failure of professional education related to training in surgical principles
and techniques and referral practices
(3) inadequate interactions between
subspecialists and referring physicians
(4) disincentives for physicians to refer
patients out of managed care networks or group practices
between clinicians representing competing disciplines
(6) conflicts of interest
on the part of academic physicians or cooperative groups.
initiatives include the following:
(1) embracing the quality of patient care as the
(2) designing clinical trials that lead to advances in patient
(3) emphasizing public education (direct consumer information) as well
as professional education
(4) partnering with local, state, and national patient advocacy groups to ensure optimal treatment for gynecologic cancers
(5) implementing practice guidelines
(6) developing referral guidelines
(7) improving communication skills of academic physicians in relating to referring physicians
(8) continuing to conduct and publish outcomes studies
(9) establishing centers of excellence.
It is time to make a commitment to substantially improving gynecologic cancer care for American women, and, I believe, the proposed initiatives will begin to accomplish this essential goal.
Cancer J 2001 Nov-Dec;7(6):450-7
PMID: 11769855 [PubMed - in process]
Intl J Gyn Cancer, 2001
Social Science & Med, 7/05
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