Surgical care for ovarian ca not what it should be.(News)

PALM SPRINGS, CALIF. -- A significant number of women in the United States are not receiving the recommended surgical procedures for ovarian cancer, results from an analysis of hospital discharge data suggest.

"Approximately 50% of women with early-stage disease are not adequately staged, and in women with advanced-stage disease, the rates of bowel resection and other procedures are lower than in institutions that report high optimal cy-toreduction rates," Dr. Barbara Goff reported at the annual meeting of the Society of Gynecologic Oncologists.

"Complication rates are similar for low- and high-volume surgeons and hospitals, but significantly more women received de-bulking procedures, lymph node dissection, and additional surgical procedures in high-volume settings," she said.

However, because the data used in the study are intended primarily for billing and lacked CPT codes, "it's very important to be cautious in interpreting these results," said Dr. Goff, a gynecologic oncologist at the University of Washington, Seattle.

Even so, Dr. Eva Chalas of the State University of New York at Stony Brook, said that the study "significantly contributes to our knowledge of how we treat ovarian cancer patients in the United States at this time." She went on to note that "despite the presence of [ovarian cancer] guidelines from National Institutes of Health, the National Comprehensive Cancer Network, and the American College of Obstetricians and Gynecologists, we continue to see women in the United States undertreated, understaged, and underdebulked."

Using data from the Health Care Utilization Project, Dr. Goff and her associates identified 10,432 women with primary diagnoses of ovarian cancer who had at least an oophorectomy in an acute care hospital in nine states between 1999 and 2002. The states were Colorado, Florida, Iowa, Maine, New Jersey, New York, South Carolina, Washington, and Wisconsin.

Women were categorized as having early-stage disease based on ICD-9 diagnosis, and comprehensive surgery was determined from a combination of ICD-9 diagnostic and procedure-based codes from the 1994 NIH guidelines for the management of women with ovarian cancer.