When experts agree, and groups such as the Society of Gynecologic Oncology and the American Cancer Society issue joint guidelines on the best way to treat a particular cancer, one would assume that patients would receive the recommended treatment.
However, for patients with non-metastatic endometrial cancer, this is not the case. Although clear evidence and national guidelines direct the use of minimally invasive or laproscopic surgery, it’s not the current practice at many medical centers. Instead, across the country, women are being subjected to unnecessary, more invasive procedures, and as a result, suffering more post operative complications at higher cost for the healthcare system. These findings from Mayo researchers appear in Obstetrics & Gynecology.
“It’s disturbing to see the discrepancy in surgical quality across the country,” says Sean Dowdy, M.D., senior author and Chair of Gynecologic Surgery at Mayo Clinic. “And it’s especially concerning to discover that characteristics such as race and insurance status impact the utilization of minimally invasive surgery.”
Dr. Dowdy and his colleagues reviewed national inpatient data for 32,560 patients treated at 1,051 hospitals between 2007 and 2011, and found that only 33.6 percent of women received minimally invasive surgery. On average, hospitals that treated few of these patients (less than 10 in the 4-year period) were even less likely (23.6 percent) to perform minimally invasive surgery.
“In contrast, at Mayo Clinic, over 90 percent of women with early stage endometrial cancer receive MIS,” he notes.
In addition to the discrepancy noted among the “less-experienced hospitals”, fewer minimally invasive surgeries were performed in conjunction with a number of other factors including: obesity, comorbidities, racial identity, and insurance status. The researchers say that none of these are valid reasons to forego minimally invasive surgery.
“Clearly we need to encourage practicing surgeons to utilize MIS, and improve patient education and awareness,” says Dr. Dowdy. “It is also important to consider centralizing care to centers with high volumes of endometrial cancer, and to require greater transparency of MIS utilization rates.”
This research was supported in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Mayo Clinic Cancer Center.