Gynecologic Oncology or Medical Oncology: What's in a Name?
2007; Lippincott Williams & Wilkins; Volume: 25; Issue: 10 Linguagem: Inglês
10.1200/jco.2006.10.2228
ISSN1527-7755
Autores Tópico(s)Intraperitoneal and Appendiceal Malignancies
ResumoPatients with advanced epithelial ovarian cancer generally require postoperative platinum-based chemotherapy in an attempt to prolong both disease-free and overall survival. Unlike most other areas of oncology, where chemotherapy has traditionally been administered by medical oncologists, postoperative chemotherapy for ovarian cancer may also be administered by gynecologic oncologists, who receive chemotherapy training as part of a surgically oriented fellowship. Nonetheless, the division of labor between gynecologic oncologists primarily trained to operate and medical oncologists trained in chemotherapy decision making, dosing, and adverse effect management, seems natural to many physicians involved in the care of patients with ovarian cancer. Physicians often work as a team, with the gynecologic oncologist managing the surgical aspects of this disease and the medical oncologist being responsible for chemotherapy administration. However, this paradigm is not universal, and the model of the gynecologic oncologist delivering both surgical as well as chemotherapeutic care is active in many parts of the United States and elsewhere in the world. In this issue of the Journal, Silber et al use the Surveillance, Epidemiology, and End Results (SEER)-Medicare data to assess survival, chemotherapy usage, and adverse effects for patients with epithelial ovarian cancer who received chemotherapy under the care of either gynecologic oncologists or medical oncologists. 1 The authors hypothesized that the survival of patients treated by medical oncologists would be superior in view of their training. Instead, Silber et al found that survival was equivalent between these two groups of subspecialists when adjusting for stage, age, histology, ethnicity, medical comorbidity, and the initial operating physician (usually a gynecologic oncologist). However, patients treated by medical oncologists tended to receive chemotherapy more frequently and have more reported adverse effects than those treated by gynecologic oncologists. The authors conclude that perhaps “medical oncologists believed in treatment intensity more than gynecologic oncologists,” and “that gynecologic oncologists had better intuition regarding when to reduce intensity in favor of quality of life.” 1 Regarding this last point, it should be noted that quality of life was not assessed as part of this study, making it impossible to draw conclusions about the effects of treatment frequency on this outcome.
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