Ovarian cancer care for the underserved: Are surgical patterns of care different in a public hospital setting?

Authors

  • Leslie R. Boyd MD,

    Corresponding author
    1. Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
    2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
    • Department of Obstetrics and Gynecology, New York University School of Medicine, 462 First Avenue, 9N1, New York, NY 10016
    Search for more papers by this author
    • Fax: (212) 263-8887

  • Akiva P. Novetsky MD,

    1. Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
    Search for more papers by this author
  • John P. Curtin MD

    1. Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
    2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
    Search for more papers by this author

  • Presented in poster form at the 2009 Annual Meeting of the American Society of Clinical Oncology; May 29-June 2, 2009; Orlando, Florida.

Abstract

BACKGROUND:

The New York City (NYC) public hospital system includes subspecialty care for gynecologic cancers, providing care to patients regardless of insurance status. The authors sought to determine the surgical patterns of care for ovarian cancer patients in the NYC public hospital system.

METHODS:

Ovarian cancer cases were identified in the New York State Department of Health Statewide Planning and Research Cooperative System database for years 2001 to 2006. Cases from NYC hospitals were separated into 2 cohorts: public and other NYC hospitals. Surgeons associated with each case were identified using the database and were stratified by volume of cases and presence of subspecialty training.

RESULTS:

A total of 12,202 admissions for ovarian cancer were identified. Of these, 3639 involved major surgery, and 187 were performed at public hospitals. There were more African American and Asian patients in the public cohort (P < .001). The primary insurer was more likely to be Medicaid or a self-payer in the public cohort (P < 0.001). Urgent or emergent admissions comprised 55% of all admissions in public hospitals, compared with 29% of admissions in other NYC hospitals (P < .001). Patients in public hospitals were less likely to have their surgery performed by a gynecologic oncologist (57% vs 74%, P < .001) and less likely to have their surgery performed by a high-volume surgeon (21% vs 47%; P < .001) compared with patients in other NYC hospitals.

CONCLUSIONS:

Ovarian cancer patients treated in public hospitals are less likely to have gynecologic oncologists and high-volume surgeons involved in their care. This is a preliminary finding that warrants further investigation. Cancer 2011. © 2010 American Cancer Society.

Ancillary