Impact of Gynecologic Oncologists on Referral Patterns and Care of Patients with Uterine Malignancies at a Community Hospital

Abstract

Objective: The purpose of this study was to assess the impact of the introduction of gynecologic oncology services at a community hospital on patterns of referral and responsibility for management of patients with uterine malignancies. The number of patients treated at, and referred from, the study hospital over a 19-year period is reported. The increase in the utilization of the gynecologic oncologist by the general gynecologist over the study period is detailed. Methods: From January 1981 to December 1999, 543 patients were diagnosed and received total or partial treatment for uterine malignancy at Hoag Memorial Hospital Presbyterian in Newport Beach, CA. Patients were categorized according to the type of treatment (surgery, radiotherapy) administered, stage of disease, and degree of gynecologic oncologist involvement with patient care. Results: Utilization of a gynecologic oncologist as a primary surgeon, assistant surgeon, or postoperative consultant increased gradually to more than 90%. The number of patients referred to other institutions for treatment declined from 24.0% to 3.1% within 5 years of the introduction of gynecologic oncology services. The number of patients receiving all treatment for uterine malignancy at the study hospital increased from 18.3/year to 36/year since the advent of gynecologic oncology services. Conclusions: The impact of gynecologic oncology subspecialty services on referral patterns of uterine cancer in a community hospital has not been explored in the literature. The availability of gynecologic oncology subspecialty services resulted in a rapid decline in referral to other institutions, an increase in the number of patients treated, and a gradual transfer of responsibility for primary management from general gynecologists to gynecologic oncologists.