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Gynecologic Oncology Centres

Key findings

In fiscal year 2016/2017, 8 of the 9 gynecologic oncology centres (GOCs) in Ontario met the surgery volume requirement of a minimum of 150 gynecology surgical cases

Measure:  Proportion of gynecologic oncology surgeries (cervix, vulvar, ovary) performed in a gynecologic oncology centre

 

Desired Direction:

 

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As of this Report:

 

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In fiscal year 2016/2017, 87% of ovarian cancer surgeries, 85% of cervical cancer surgeries and 62% of endometrial cancer surgeries were being performed in the 9 GOCs that are currently open. Furthermore, 99% of vulvar cancer surgeries were performed at a GOC in fiscal year 2016/2017, which exceeds Cancer Care Ontario’s target of 90%.

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 care from 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 gynecologic oncology centre?

  • In 2013, Cancer Care Ontario developed the Organizational Guideline for Gynecologic Oncology Services in Ontario: Guideline Recommendations, which outlines the optimal organization of gynecologic oncology services in Ontario to ensure high-quality care and optimal cancer treatment outcomes [1].
  • The recommendations in the guideline are based on evidence and expert consensus. 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 gynecology 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 have low-grade cancer (i.e., Grade 1).
    • Radiation therapy for gynecologic cancers.
    • Systemic therapy for gynecologic cancers.
  • Affiliated centres must 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.

Figure 1. Proportion of gynecologic surgeries performed at a gynecologic oncology centre, by type of cancer, fiscal year 2013/2014 to fiscal year 2016/2017

More information regarding the methodology is available.

Report date: December 11, 2017

Data source: CIHI-DAD, CIHI-NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Figure 2. Gynecologic surgery volumes by hospital and type of cancer, fiscal year 2016/2017

More information regarding the methodology is available.

Report date: December 11, 2017

Data source: CIHI-DAD, CIHI-NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. Designated centers are marked by '*' next to the hospital name
  2. Only hospitals with more than five surgeries per year are shown
  3. See technical notes for detailed methodology and inclusions/exclusions
  4. † Values have been suppressed due to small cell counts

 

Data Table 1. Proportion of gynecologic surgeries performed at a gynecologic oncology centre, by type of cancer, fiscal year 2013/2014 to fiscal year 2016/2017

Disease site Percentage of gynecologic surgeries performed at GOC in fiscal year 2013/2014 Number of gynecologic surgeries performed at GOC in fiscal year 2013/2014 Total number of gynecologic surgeries in fiscal year 2013/2014 Lower confidence interval in fiscal year 2013/2014 Upper confidence interval in fiscal year 2013/2014 Percentage of gynecologic surgeries performed at GOC in fiscal year 2014/2015 Number of gynecologic surgeries performed at GOC in fiscal year 2014/2015 Total number of gynecologic surgeries in fiscal year 2014/2015 Lower confidence interval in fiscal year 2014/2015 Upper confidence interval in fiscal year 2014/2015 Percentage of gynecologic surgeries performed at GOC in fiscal year 2015/2016 Number of gynecologic surgeries performed at GOC in fiscal year 2015/2016 Total number of gynecologic surgeries in fiscal year 2015/2016 Lower confidence interval in fiscal year 2015/2016 Upper confidence interval in fiscal year 2015/2016 Percentage of gynecologic surgeries performed at GOC in fiscal year 2016/2017 Number of gynecologic surgeries performed at GOC in fiscal year 2016/2017 Total number of gynecologic surgeries in fiscal year 2016/2017 Lower confidence interval in fiscal year 2016/2017 Upper confidence interval in fiscal year 2016/2017
Cervical 77.8 133 171 71.3 100.0 83.1 133 160 77.0 100.0 85.1 143 168 79.4 100.0 85.0 159 187 79.7 100.0
Vulvar 97.0 98 101 93.2 100.0 97.3 108 111 93.8 100.0 95.0 114 120 90.7 100.0 99.2 122 123 97.2 100.0
Ovary 75.8 810 1,069 73.2 83.0 80.6 801 994 78.1 88.1 82.8 881 1,064 80.5 89.8 86.5 849 981 84.4 93.8
Endometrium 56.5 1,124 1,990 54.3 61.2 59.5 1,218 2,047 57.4 64.1 58.8 1,276 2,170 56.7 63.2 61.7 1,405 2,277 59.7 65.9

Report date: December 11, 2017

Data source: CIHI-DAD, CIHI-NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Data Table 2. Gynecologic surgery volumes by hospital and type of cancer, fiscal year 2016/2017

Hospital Number of gynecologic surgeries for cervical/vulvar/ovarian cancer Number of gynecologic surgeries for endometrial cancer
Province 1,291 2,277
ALEXANDRA MARINE AND GENERAL HOSPITAL Ɨ Ɨ
ALMONTE GENERAL HOSPITAL 0 Ɨ
BLUEWATER HEALTH Ɨ 13
BRANT COMMUNITY HEALTHCARE SYS 0 14
BROCKVILLE GENERAL HOSPITAL 0 Ɨ
CAMBRIDGE MEMORIAL HOSPITAL Ɨ 10
COLLINGWOOD GENERAL AND MARINE HOSPITAL Ɨ 7
CORNWALL COMMUNITY HOSPITAL Ɨ 9
DRYDEN REGIONAL HEALTH CENTRE 0 Ɨ
ERIE SHORES HEALTHCARE Ɨ Ɨ
GRAND RIVER HOSPITAL CORP 9 26
GREY BRUCE HEALTH SERVICES Ɨ 13
GROVES MEMORIAL COMMUNITY HOSPITAL 0 Ɨ
GUELPH GENERAL HOSPITAL Ɨ 14
HALTON HEALTHCARE SERVICES CORP Ɨ 26
HAMILTON HEALTH SCIENCES CORP* 180 181
HAWKESBURY AND DISTRICT GENERAL HOSPITAL 0 Ɨ
HEADWATERS HEALTH CARE CENTRE-DUFFERIN Ɨ 6
HEALTH SCIENCES NORTH Ɨ 25
HÔPITAL MONTFORT Ɨ Ɨ
HUMBER RIVER HOSPITAL 8 43
JOSEPH BRANT HOSPITAL Ɨ 24
KINGSTON GENERAL AND HOTEL DIEU HOSPITAL* 69 127
KIRKLAND AND DISTRICT HOSPITAL Ɨ Ɨ
LAKERIDGE HEALTH Ɨ 16
LONDON HLTH SCIENCES CTR* 158 189
MACKENZIE HEALTH Ɨ 14
MARKHAM STOUFFVILLE HOSPITAL 11 19
MUSKOKA ALGONQUIN HEALTHCARE Ɨ Ɨ
NIAGARA HEALTH SYSTEM 10 34
NORFOLK GENERAL HOSPITAL Ɨ Ɨ
NORTH BAY REGIONAL HEALTH CENTRE Ɨ 12
NORTH YORK GENERAL HOSPITAL Ɨ 35
NORTHUMBERLAND HILLS HOSPITAL 0 Ɨ
ORILLIA SOLDIERS' MEMORIAL HOSPITAL Ɨ 20
OTTAWA HOSPITAL ( THE )* 126 206
PEMBROKE REGIONAL HOSPITAL INC. Ɨ Ɨ
PERTH AND SMITHS FALLS DIST Ɨ Ɨ
PETERBOROUGH REGIONAL HEALTH CENTRE Ɨ 17
PUBLIC GENERAL HOSP SOCIETY OF CHATHAM Ɨ 8
QUEENSWAY-CARLETON HOSPITAL Ɨ Ɨ
QUINTE HEALTHCARE CORPORATION Ɨ 16
ROSS MEMORIAL HOSPITAL Ɨ Ɨ
ROYAL VICTORIA REGIONAL HEALTH CENTRE* 82 108
SAULT AREA HOSPITAL Ɨ 15
SCARBOROUGH AND ROUGE HOSPITAL 9 91
SINAI HEALTH SYSTEM* 11 61
SOUTHLAKE REGIONAL HEALTH CENTRE Ɨ 36
ST JOSEPH'S GENERAL HOSPITAL 0 Ɨ
ST JOSEPH'S HEALTH CENTRE Ɨ 8
ST JOSEPH'S HEALTHCARE HAMILTON Ɨ 40
ST MICHAEL'S HOSPITAL Ɨ 42
ST THOMAS-ELGIN GENERAL HOSPITAL Ɨ Ɨ
ST.JOSEPH'S HEALTH CARE,LONDON Ɨ 0
STEVENSON MEMORIAL HOSPITAL ALLISTON Ɨ Ɨ
STRATFORD GENERAL HOSPITAL Ɨ 16
SUNNYBROOK HEALTH SCIENCES CENTRE* 178 189
THUNDER BAY REGIONAL HLTH SCIENCES CTR Ɨ 12
TIMMINS AND DISTRICT GENERAL HOSPITAL Ɨ 11
TORONTO EAST HEALTH NETWORK Ɨ 21
TRILLIUM HEALTH PARTNERS* 115 162
UNIVERSITY HEALTH NETWORK* 211 182
WILLIAM OSLER HEALTH SYSTEM 7 50
WINCHESTER DISTRICT MEMORIAL HOSPITAL 0 8
WINDSOR REGIONAL HOSPITAL 12 35
WOODSTOCK GENERAL HOSPITAL Ɨ 9

Report date: December 11, 2017

Data source: CIHI-DAD, CIHI-NACRS

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. Designated centers are marked by '*' next to the hospital name
  2. Only hospitals with more than five surgeries per year are shown
  3. See technical notes for detailed methodology and inclusions/exclusions
  4. † Values have been suppressed due to small cell counts

 

What do the results show?

A large proportion of gynecologic oncology surgeries are being performed at a gynecologic oncology centre (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 already were being performed in GOCs prior to the formal designation. Cancer Care Ontario’s aim is for 90% of these surgeries to be performed in GOCs in the future.
  • As of fiscal year 2016/2017, 87% of ovarian cancer surgeries and 85% of cervical cancer surgeries were performed in GOCs. Ovarian cancer surgery rates represent an improvement from fiscal year 2015/2016, when 83% were performed in GOCs.
  • The percentage of vulvar cancer surgeries being performed at GOCs was 99% in fiscal year 2016/2017, which exceeds Cancer Care Ontario’s aim of 90%.
  • The number of endometrial cancer surgeries performed in a GOC increased to 62% in fiscal year 2016/2017 from 59% in fiscal year 2015/16. 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 gynecologic oncology centres already perform a high volume of gynecologic oncology surgeries in the province (Figure 2).

  • There are currently 9 GOCs in Ontario. In fiscal year 2016/2017, 8 of the 9 centres met the surgery volume requirement of a minimum of 150 gynecology surgical cases. They also performed a significant portion of surgery for endometrial cancer.
  • Royal Victoria Hospital was recently designated a GOC, and it has implemented a gynecologic oncology program. Its surgery volumes have increased in recent years, and the centre met the minimum surgical volume target in fiscal year 2016/2017.
  • Mount Sinai Hospital was also recently designated a GOC, and 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 by nearly half in fiscal year 2016/2017. Several non-GOC hospitals, however, continue to perform surgery for these cases. As implementation of the guidelines continues, it is anticipated that these surgeries will transfer to a GOC. Furthermore, it is anticipated that some Grade 1 endometrial volumes will increasingly 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 care [2]. In addition, it has been demonstrated that gynecologic patients treated at hospitals with higher volumes have improved survival (by about 1 year) compared to those who received their care at centers with lower volumes, independent of prognostic factors [3].
  • 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

For more information on GOCs, please visit the Cancer Care Ontario Organizational Guideline for Gynecologic Oncology Services in Ontario: Guideline Recommendations

Notes

  1. 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 here.
  2. National Health Service Centre for Reviews and Dissemination. Management of gynaecological cancers. Eff Health Care. 1999;5(3):1–12.
  3. 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. Abstract 89. SGO Annual Meeting on Women’s Cancer; 2014 Mar 22–25; Tampa, Florida.