||As of this Report
|Volume of gynecologic oncology surgeries performed in a GOC
| See Methodology and Approach to find out how the ratings are calculated.
As of Fiscal Year (FY) 2014/2015, 81% of ovarian cancer surgeries, 83% of cervical cancer surgeries and 54% of endometrial cancer surgeries were being performed in the 9 gynecologic oncology centres (GOCs) that are currently open in Ontario. Furthermore, 97% of vulvar cancer surgeries were performed at a GOC in FY2014/2015, which exceeds Cancer Care Ontario’s goal of 90%.
In FY2014/2015, 6 of the 9 GOCs met the surgery volume requirement of a minimum of 150 new surgical cases.
What is gynecologic oncology?
- Gynecologic oncology refers to the specialty that treats tumours arising in the female reproductive system, including malignancies of the ovaries, endometrium (lining of the uterus), uterine cervix, vulva and vagina.
- Many gynecologic cancers require the attention of a multidisciplinary team for maximum patient benefit. This includes medical and radiation oncology, pathology, radiology and surgery.
- In Ontario, gynecologic oncology surgery is performed by gynecologists and gynecologic oncologists.
What is a GOC?
- In 2013, Cancer Care Ontario developed the Organizational Guideline for Gynecologic Oncology Services in Ontario: Guideline Recommendations (the Guideline), which outlines the optimal organization of gynecologic oncology services in Ontario to ensure high-quality care and optimal cancer treatment outcomes1.
- The recommendations in the Guideline are based on evidence and expert consensus, and they include criteria for the number and training of gynecologic surgeons, the availability of multidisciplinary care and hospital resources, and the expected minimum number of procedures performed in a fiscal year. A GOC is an institution that meets—or is committed to meeting—those recommendations.
- All patients undergoing definitive surgical treatment for cervical cancer, endometrial cancer (grade 2 or 3), ovarian cancer, vulvar cancer and vaginal cancer should be treated by a gynecologic oncologist at a GOC.
- A GOC should include all members of the multidisciplinary team to ensure optimal care for patients. This includes a minimum of 2 full-time gynecologic oncologists and 2 radiation oncologists.
- In addition to surgical care, GOCs should be equipped to provide radiation therapy and systemic therapy for all invasive gynecologic cancers.
- A GOC should perform a minimum of 150 surgical cases per fiscal year, a requirement that is based on a systematic review of the literature and expert consensus.
- To provide the best care, hospitals must have the necessary specialized physical and human resources to provide safe, high-quality surgical care.
What is an affiliated centre?
- Affiliated centres may provide any or all of the following services:
- surgery for endometrial cancer patients who preoperatively are determined to be have low grade cancer (i.e. grade 1);
- radiation therapy for gynecologic cancers; and
- systemic therapy for gynecologic cancers.
- Affiliated centres have established partnerships with a GOC that includes access to multidisciplinary review.
- Affiliated centres that perform gynecologic oncology surgery must:
- have a pathology quality assurance review process;
- perform surgery only for low-grade endometrial cancer patients; and
- offer minimally invasive surgery for low-grade endometrial cancer patients.
While the opportunity to access care close to home is important for patients, it must be balanced by the need for high-quality, specialized care.
What do the results show?
A large proportion of gynecologic oncology surgeries are being performed at a GOC (Figure 1).
- Figure 1 highlights the proportion of gynecologic oncology surgeries performed in a GOC.
- GOCs were designated in 2014 and the Guideline recommendations are currently being implemented across Ontario. Historical data show that a large proportion of surgeries for cervical, vulvar and ovarian cancers were already being performed in GOCs prior to the formal designation. Cancer Care Ontario’s goal is for 90% of these surgeries to be performed in GOCs in the future.
- As of FY2014/2015, 81% of ovarian cancer surgeries and 83% of cervical cancer surgeries were performed in GOCs. Both of these rates represent an improvement from FY2013/2014, when 76% and 75% (respectively) were performed in GOCs.
- The percentage of vulvar cancer surgeries being performed at GOCs remains stable at 97%, which already exceeds Cancer Care Ontario’s aim.
- There also was an improvement in the number of endometrial cancer surgeries performed in a GOC, with the rate increasing from 56% in FY2013/2014 to 60% in FY2014/2015. It is important to note that surgery for grade 1 endometrial cancer does not need to be performed in a GOC, and therefore there will be no target for the proportion of endometrial cancer surgeries that should be performed in a GOC.
The majority of GOCs already perform a high volume of gynecologic oncology surgeries in the province (Figure 2).
- There are currently 9 GOCs in Ontario. In FY2014/2015, 6 of the 9 centres met the surgery volume requirement of a minimum of 150 new surgical cases. A significant proportion of surgery was performed for endometrial cancer.
- Royal Victoria Hospital was recently designated a GOC, and it is in the process of implementing its gynecologic oncology program. As the program matures, it is anticipated that its volumes will grow to meet the minimum surgical volume target.
- The volume of surgeries for cervical, vulvar or ovarian cancer performed at non-GOC hospitals decreased in FY2014/2015. Several non-GOC hospitals, however, continue to perform surgery for these cases. As implementation of the Guideline continues, it is anticipated that these surgeries will transfer to a GOC. Furthermore, it is anticipated that some grade 1 endometrial volumes increasingly will be performed at affiliated centres.
- Published evidence suggests that patients receiving treatment in low-volume settings are less likely to receive multidisciplinary care, which has been identified as a key contributor to quality care2. In addition, it has been demonstrated that gynecologic patients treated at hospitals with higher volumes had improved survival (by about 1 year) compared to those who received their care at centers with lower volumes, independent of prognostic factors3.
- While access to care close to home is important for patients, the Guideline recommendations aim to balance access to care with benefits of high-quality, specialized cancer treatment.
Find out more
More information about GOCs is available through the Cancer Care Ontario Guidelines.
- Fung-Kee-Fung M, Kennedy EB, Biagi J, Colgan T, D’Souza D, Elit L, et al. Organizational guideline for gynecologic oncology services in Ontario: guideline recommendations [Internet]. Toronto: Cancer Care Ontario; 2013. Available from: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=282212.
- National Health Service Centre for Reviews and Dissemination. Management of gynaecological cancers. Eff Health Care. 1999; 5(3):1–12.
- Lin JF, Alexander AL, Beriwal S, et al. Characteristics of high-volume gynecologic cancer centers—framework toward centers of excellence: a National Cancer Data Base (NCDB) study. SGO Annual Meeting on Women’s Cancer. Abstract 89. Presented 2014 Mar 24.