Gynecologic Oncology Centres
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
As of this Report:
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 .
- 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.
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 . 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 .
- 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