Objectives: Documented variations in practice compelled the need to establish a network that would facilitate the flow of patients through the care continuum of a provincial health care system in accordance with best practices. Therefore, a guideline was developed to provide recommendations for the optimal organization of gynecologic oncology services in this higher resource location to improve access to multidisciplinary care and appropriate treatment.
Methods: A systematic review was conducted of Web sites of international guideline developers, relevant cancer agencies, and Medline and EMBASE from 1996 to 2011 using search terms related to gynecologic malignancies, combined with organization of services, patterns of care, and various facility and physician characteristics. The results of the review were combined with expert consensus and stakeholder consultation to develop a gynecologic oncology services organizational guideline.
Results: The evidence review yielded a lower quality evidence base; therefore, recommendations were determined through consensus, including guidance for physician and hospital specialization, and other domains including human and physical resources. Definitive surgical treatment of most invasive cancers by subspecialist gynecologic oncologists is recommended. In addition, it is recommended that these subspecialists provide care within designated gynecologic oncology centers. The recommendations also outline which services, such as radiation therapy, may be provided in other affiliated centers. Multidisciplinary team management is also endorsed.
Conclusions: These recommendations are intended to allow a collaborative community of practice, supported by formal interorganizational processes, to evolve to facilitate adherence to guidelines and best practices at a system-wide level.
*Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada; †Program in Evidence-Based Care, Cancer Care Ontario and Department of Oncology, McMaster University, Hamilton, Ontario, Canada; ‡Southeastern Ontario Health Sciences Centre, Palliative Care Medicine Program, Kingston, Ontario, Canada; §Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; ∥London Regional Cancer Centre, London, United Kingdom; ¶Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; #Surgical Oncology Program, Cancer Care Ontario, Canada; and **Department of Gynecology-Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Address correspondence and reprint requests to Michael Fung-Kee-Fung, MBBS, MBA, Gynecologic Oncology Disease Site Group, Cancer Care Ontario’s Program in Evidence-Based Care c/o Erin B. Kennedy, Health Research Methodologist, Program in Evidence-Based Care, Cancer Care Ontario McMaster University, Juravinski Site, 711 Concession St, Hamilton, Ontario L8V 1C3, Canada. E-mail: firstname.lastname@example.org.
The work of the Program in Evidence-Based Care is supported by the Ontario Ministry of Health and Long-Term Care through Cancer Care Ontario and is editorially independent from its funding source.
Laurie M. Elit reports receiving compensation as a gynecologic oncologist by the Ontario Ministry of Health and Long-term Care. Terry Colgan received employment income and had managerial responsibility as a Section Head for Cytopathology and Gynaecological Pathology at Mount Sinai Hospital in Toronto, Ontario, and his professional income could be affected by more than $10,000 per year depending on these guideline recommendations. Dr. Colgan also reported receiving more than $5000 in a single year as a consultant pathologist with LifeLabs. The remaining authors have no conflicts of interest to declare.
Received July 4, 2014
Received in revised form December 24, 2014
Accepted December 25, 2014