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Hill SK, Bempong-Ahun N, Okolo ID, Lalla AT, Worku D, Asres T, Philpotts L, Fallah PN, Varallo J, Corlew S, Kamfwa P, Parham GP, Hicks ML, Ibbotson G, Randall T. Improving access to safe, quality surgical care for gynecologic cancers through capacity-building interventions in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024; 165:552-561. [PMID: 37927080 DOI: 10.1002/ijgo.15156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/16/2023] [Accepted: 09/10/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Following the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low- and middle-income countries (LMICs). A well-integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task-sharing and training of gynecologic oncologists (GynOncs). OBJECTIVES This review aimed to explore existing literature on capacity-building for surgical management of early-stage gynecologic cancers. SEARCH STRATEGY The search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE. SELECTION CRITERIA Studies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task-sharing, or outcomes following operation by subspecialists compared to specialists were included. DATA COLLECTION AND ANALYSIS Results were synthesized using narrative synthesis approach with emergence of key themes by frequency. MAIN RESULTS The scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non-subspecialized care, and task-shifting/-sharing. CONCLUSIONS A multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity-building and task-sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost-effectiveness.
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Affiliation(s)
- Sarah K Hill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Isioma Dianne Okolo
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amber Trujillo Lalla
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dawit Worku
- Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - Tadios Asres
- Department of Obstetrics and Gynecology, Rwanda Military Hospital (RMH), Kigali, Rwanda
| | - Lisa Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Parisa N Fallah
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John Varallo
- The Global Surgery Foundation, Geneva, Switzerland
| | - Scott Corlew
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Kamfwa
- Department of Gynecologic Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Groesbeck P Parham
- Women and Newborn Hospital-University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Michael L Hicks
- Women and Newborn Hospital-University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Gynecologic Oncology, Michigan Cancer Institute, St. Joseph Mercy Oakland, Pontiac, USA
| | - Geoffrey Ibbotson
- The Global Surgery Foundation, Geneva, Switzerland
- United Nations Institute for Training and Research, Geneva, Switzerland
| | - Thomas Randall
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Ding Y, Zhang X, Qiu J, Zhang J, Hua K. Assessment of ESGO Quality Indicators in Cervical Cancer Surgery: A Real-World Study in a High-Volume Chinese Hospital. Front Oncol 2022; 12:802433. [PMID: 35145915 PMCID: PMC8821940 DOI: 10.3389/fonc.2022.802433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
The ESGO developed a list of fifteen quality indicators for cervical cancer surgery in order to audit and improve clinical practice in 2020. However, data from the developing countries with high incidence rates of cervical cancer is still lacking. Therefore, we conducted a retrospective study of 7081 cases diagnosed as cervical cancer between 2014 and 2019 in a Chinese single center according to the quality indicators proposed by ESGO. A total of 5952 patients underwent radical procedures, with an average of 992.0 per year. All surgeries were performed or supervised by a certified gynecologic oncologist as surgical qualification grading system has been established. Compared with the low-volume group, patients in the high-volume group (≥15 cases/year) had a shorter hospital stay (P<0.001), more free surgical margins (P=0.031), and less complications (P<0.001), but the 5-year recurrence-free survival and overall survival rates were similar (P>0.05). Treatment was not planned at a multidisciplinary team meeting but with the consultation system. The required preoperative workup was incomplete in 19.7% of patients with pelvic MRI and 45.7% of patients with PET-CT. A total of 1459 (20.6%) patients experienced at least one complication after surgery. The CDC grade IIIb or higher complications occurred in 80 patients, accounting for 5.5% complications. The urological fistula rate within 30 postoperative days were 0.3%. After primary surgical treatment, 97.4% patients had clear vaginal and parametrial margins. After restaging FIGO 2009 to FIGO 2018 system, 14.7% patients with a stage T1b disease were T-upstaged. After a median follow-up of 42 months, recurrence occurred in 448 patients, and 82.1% patients recurred within 2 years. The 2-year RFS rate of patients with pT1b1N0 was 97.3% in 2009 FIGO staging system. Lymph node staging was performed in 99.0% patients with a stage T1 disease. After a primary surgical treatment for a stage pT1b1N0 disease, 28.3% patients received adjuvant chemoradiotherapy. Above all, most of quality indicators reached the targets, except four quality indicators. The quality indicators of ESGO should be popularized and applied in China to guarantee quality of surgery.
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Affiliation(s)
- Yan Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xuyin Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Junjun Qiu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jianfeng Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Gynecology Quality Control Center, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Gynecology Quality Control Center, Shanghai, China
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3
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Ohta T, Nagase S, Okui Y, Enomoto T, Yamagami W, Mikami M, Tokunaga H, Ino K, Ushijima K, Shozu M, Tashiro H, Mandai M, Miyamoto S, Morishige KI, Yoshida Y, Yoshino K, Saito T, Kobayashi E, Kobayashi H, Takekuma M, Terai Y, Fujii T, Kanao H, Aoki D, Katabuchi H, Yaegashi N. Surveillance of radical hysterectomy for early-stage cervical cancer in the early experienced period of minimally invasive surgery in Japan. Int J Clin Oncol 2021; 26:2318-2330. [PMID: 34435284 DOI: 10.1007/s10147-021-02017-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of our study was to conduct a detailed survey of radical hysterectomy in Japanese patients with early-stage cervical cancer, and to compare oncologic outcomes between open and minimally invasive radical hysterectomy. METHODS In Japan during 2015, the medical records of 929 patients with FIGO stage IB1 and IIA disease treated with radical hysterectomy were retrospectively reviewed. We assessed patients' characteristics, disease-free survival (DFS), overall survival (OS) and prognostic factors for survival. RESULTS The median patient age was 44 (20-80) years. Most patients (94.4%) had stage IB1 disease. Of the patients who underwent radical hysterectomy, 91.2% underwent open surgery and 8.8% underwent minimally invasive surgery (MIS). The median follow-up period was 40.8 months (range, 0.49-51.1 months). The rate of DFS and OS at 4 years in all patients was 88.3% and 96.4%, respectively. Multivariate analysis identified age (≥ 47), adenocarcinoma histology, tumor size (≥ 2 cm), parametrial invasion, positive lymph node metastasis and institutional accreditation as independent predictors of recurrence, and adenocarcinoma, other cell types, and positive lymph node metastasis as independent predictors of death. Oncologic outcomes in all patients were similar between open and MIS, including DFS and OS. CONCLUSION The survival rate of the Japanese patients underwent radical hysterectomy for early-stage cervical cancer was favorable. No significant differences were observed for DFS and OS between open and MIS performed by a limited number of surgeons at a limited number of facilities in Japan. Further investigations are required to identify the appropriate patients might benefit from MIS.
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Affiliation(s)
- Tsuyoshi Ohta
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
| | - Satoru Nagase
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan.
| | - Yosuke Okui
- Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Hideki Tokunaga
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuhiko Ino
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology,, Kurume University School of Medicine, Kurume, Japan
| | - Makio Shozu
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hironori Tashiro
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shingo Miyamoto
- Department of Obstetrics and Gynecology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Ken-Ichirou Morishige
- Department of Obstetrics and Gynecology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshio Yoshida
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Fukui, Yoshida, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshiaki Saito
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Munetaka Takekuma
- Department of Gynecologic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuma Fujii
- Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Aichi, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Nobuo Yaegashi
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Thomas V, Chandy RG, Sebastian A, Thomas A, Thomas DS, Ram TS, Peedicayil A. Treatment Outcomes of Early Carcinoma Cervix Before and After Sub-specialization. Indian J Surg Oncol 2021; 12:78-85. [PMID: 33814836 DOI: 10.1007/s13193-020-01228-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/15/2020] [Indexed: 12/24/2022] Open
Abstract
This study aimed to compare the treatment outcomes in carcinoma cervix before and after gynecologic oncology sub-specialization at a tertiary care hospital, in India. This was a retrospective cohort study comparing women with operable cervical cancer who underwent radical hysterectomy before and after gynecologic oncology sub-specialization. Electronic medical records of women operated for early carcinoma cervix between 2001 and 2010 and 2011-2015 were reviewed and compared for treatment and oncological outcomes. Seventy-four patients were operated over 5 years after sub-specialization as against 59 over 10 years before sub-specialization, with similar clinical characteristics. After surgical-pathological examination, both cohorts were comparable with regard to mean tumor size, lymph nodes retrieved, deep stromal invasion, and involvement of lymph nodes, parametrium, and vaginal margins. After sub-specialization, the rate of intraoperative (3% versus 14%, p = 0.018) and postoperative complications (15% versus 46%, p < 0.001) was lower. Adjuvant radiation was used more after sub-specialization (50% versus 24%, p < 0.001). The follow-up rates were similar in both groups with comparable 5-year recurrence-free survival and overall survival rates. The hazard ratio for death after sub-specialization was 0.39 (95% CI 0.12 to 1.22) after adjusting for histology, stage, grade, and presence of intermediate or high risk factors. Gynecological oncologic sub-specialization decreased intraoperative and postoperative complications, improved pathological reporting, and enabled appropriate tailoring of adjuvant therapy.
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Affiliation(s)
- Vinotha Thomas
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, 632004 India
| | - Rachel G Chandy
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, 632004 India
| | - Ajit Sebastian
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, 632004 India
| | - Anitha Thomas
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, 632004 India
| | - Dhanya S Thomas
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, 632004 India
| | - Thomas S Ram
- Department of Radiation Oncology, Christian Medical College, Vellore, India
| | - Abraham Peedicayil
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, 632004 India
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Allanson ER, Powell A, Bulsara M, Lee HL, Denny L, Leung Y, Cohen P. Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis. PLoS One 2019; 14:e0217775. [PMID: 31269024 PMCID: PMC6608935 DOI: 10.1371/journal.pone.0217775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 05/19/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate morbidity for patients after the primary surgical management of cervical cancer in low and middle-income countries (LMIC). METHODS The Pubmed, Cochrane, the Cochrane Central Register of Controlled Trials, Embase, LILACS and CINAHL were searched for published studies from 1st Jan 2000 to 30th June 2017 reporting outcomes of surgical management of cervical cancer in LMIC. Random-effects meta-analytical models were used to calculate pooled estimates of surgical complications including blood transfusions, ureteric, bladder, bowel, vascular and nerve injury, fistulae and thromboembolic events. Secondary outcomes included five-year progression free (PFS) and overall survival (OS). FINDINGS Data were available for 46 studies, including 10,847 patients from 11 middle income countries. Pooled estimates were: blood transfusion 29% (95%CI 0.19-0.41, P = 0.00, I2 = 97.81), nerve injury 1% (95%CI 0.00-0.03, I2 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01-0.01, I2 = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01-0.02, P = 0.10, I2 = 32.2), ureteric injury 1% (95%CI 0.01-0.01, I2 0.00, P = 0.64), vascular injury 2% (95% CI 0.01-0.03, I2 60.22, P = 0.00), fistula 2% (95%CI 0.01-0.03, I2 = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00-0.01, I2 26.69, P = 0.25), and infection 8% (95%CI 0.04-0.12, I2 95.72, P = 0.00). 5-year PFS was 83% for laparotomy, 84% for laparoscopy and OS was 85% for laparotomy cases and 80% for laparoscopy. CONCLUSION This is the first systematic review and meta-analysis of surgical morbidity in cervical cancer in LMIC, which highlights the limitations of the current data and provides a benchmark for future health services research and policy implementation.
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Affiliation(s)
- Emma R. Allanson
- Division of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Western Australia, Crawley, WA, Australia
- * E-mail:
| | - Aime Powell
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Hong Lim Lee
- Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, WA, Australia
| | - Lynette Denny
- Department Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecological Cancer Research Centre, Cape Town, South Africa
| | - Yee Leung
- Division of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Western Australia, Crawley, WA, Australia
| | - Paul Cohen
- Division of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Western Australia, Crawley, WA, Australia
- Department of Gynaecological Oncology, Bendat Family Comprehensive Cancer Centre, St John of God, Subiaco, WA, Australia
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Lightfoot MD, Esselen KM, Haviland MJ, Dalrymple JL, Awtrey CS, Garrett LA, Hacker MR, Liu FW. Participation in global health delivery: Survey results from the Society of Gynecologic Oncology. Gynecol Oncol Rep 2018; 26:7-10. [PMID: 30140725 PMCID: PMC6104590 DOI: 10.1016/j.gore.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 11/29/2022] Open
Abstract
•Gynecologic oncologists face multiple barriers in participating in global health.•Several barriers may be addressed at the institutional level.•Most global health experiences involved direct patient care, while only a small proportion involved research.•Gynecologic oncologists receive little structured training in global health.
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Affiliation(s)
- Michelle D.S. Lightfoot
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Obstetrics and Gynecology, United States
| | - Katharine M. Esselen
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, United States
| | - Miriam J. Haviland
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Obstetrics and Gynecology, Division of Research, United States
| | - John L. Dalrymple
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, United States
| | - Christopher S. Awtrey
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, United States
| | - Leslie A. Garrett
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, United States
| | - Michele R. Hacker
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Obstetrics and Gynecology, Division of Research, United States
| | - Fong W. Liu
- Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, United States
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Mikami M, Shida M, Shibata T, Katabuchi H, Kigawa J, Aoki D, Yaegashi N. Impact of institutional accreditation by the Japan Society of Gynecologic Oncology on the treatment and survival of women with cervical cancer. J Gynecol Oncol 2017; 29:e23. [PMID: 29400016 PMCID: PMC5823984 DOI: 10.3802/jgo.2018.29.e23] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/14/2017] [Accepted: 12/08/2017] [Indexed: 12/20/2022] Open
Abstract
Objective The Japan Society of Gynecologic Oncology (JSGO) initiated a nation-wide training system for the education and certification for gynecologic oncologists in 2005. To assess the impact of the quality of the JSGO-accredited institutions, JSGO undertook an analysis of the Uterine Cervical Cancer Registry of the Japan Society of Obstetrics and Gynecology (JSOG) to determine the effectiveness of the JSGO-accredited institutions on the treatment and survival of women with cervical cancer. Methods The effectiveness of 119 JSGO-accredited institutions and 125 non-JSGO-accredited institutions on the treatment and survival of women with cervical cancer were compared by analyzing the tumor characteristics, treatment patterns, and survival outcomes of women with stage T1B–T4 cervical cancer utilizing the data in the JSOG nation-wide registry for cervical cancer (2006–2009). Results A total of 14,185 eligible women were identified: 10,920 (77.0%) cases for 119 JSGO-accredited institutions and 3,265 (23.0%) cases for 125 non-accredited institutions. A multivariate analysis showed that age, stage, histology type, and treatment pattern were independently associated with mortality. Moreover, women who received treatment at the JSGO-accredited institutions had a significantly decreased mortality risk compared to non-accredited institutions (adjusted hazard ratio [aHR]=0.843; 95% confidence interval [CI]=0.784–0.905). Similar findings on multivariate analysis were seen among subset of women who received surgery alone (aHR=0.552; 95% CI=0.393–0.775) and among women who received radiotherapy (aHR=0.845; 95% CI=0.766–0.931). Conclusion Successful implementation of gynecologic oncology accrediting institution was associated with improved survival outcome of women with cervical cancer in Japan.
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Affiliation(s)
- Mikio Mikami
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
| | - Masako Shida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
| | - Takeo Shibata
- Department of Molecular Life Science, Tokai University School of Medicine, Isehara, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Kumamoto University, University Faculty of Life Sciences, Kumamoto, Japan
| | - Junzo Kigawa
- Department of Obstetrics and Gynecology, Tottori Prefectural Hospital, Tottori, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, Japan
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