In the Journals

Disparities persist between gynecologic cancer treatment at public, private hospitals

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February 17, 2016

Patients with gynecologic cancer treated at public hospitals experienced longer time to surgery and a greater number of preoperative visits than those treated at private centers, according to the results of a retrospective study.

“We noticed that within our two institutions, a public and a private hospital — despite having the same physicians making decisions about who should go to the operating room and what kinds of preoperative workups were needed — it was taking much longer for our patients at the public hospital to get into the operating room,” Melissa K. Frey, MD, gynecologic oncology fellow at New York University Langone Medical Center, told HemOnc Today. “The preoperative experience of these patients appeared to be more time-consuming. We felt that if we could identify where the barriers were, we could help make a system that improves this process.”

Melissa Frey

Melissa K. Frey, MD

Prior research has chronicled disparities of care in the treatment of gynecologic cancers. Factors including race, ethnicity and socioeconomic status have been associated with delayed diagnoses and longer surgical wait times, according to study background.

Frey and colleagues conducted a retrospective review of 257 patients scheduled for gynecologic surgery at a public (n = 69) or private (n = 188) hospital staffed by the same team of physicians between July 2013 and July 2014.

Endometrial cancer served as the most common diagnosis (n = 137); other malignancies included ovarian cancer (n = 70), cervical cancer or dysplasia (n = 37), vulvar cancer or dysplasia (n = 10), and vaginal cancer or dysplasia (n = 3).

Patients treated at private hospitals tended to be older (mean age at diagnosis, 58 years vs. 52 years; P = .004) and more likely to hold private insurance (65% vs. 3%; P < .001).

Seventy percent of patients treated at a public hospital had Medicaid.

However, patients at both hospitals had similar comorbidity levels (median Charlson Comorbidity Index, 6 for both).

Patients treated at private hospitals had an average of two preoperative visits, compared with four at public hospitals (P < .001).

Surgical wait times differed by institution as well, with patients at public hospitals waiting nearly twice as long on average than patients treated in private centers (median wait time, 63 days vs. 34 days; P < .001).

A greater percentage of patients at public hospitals waited 85 days or more for surgery (33% vs. 9%; P < .001). Further, those treated at public hospitals experienced longer intervals between diagnosis and surgical booking (28 days vs. 14 days; P < .001), as well as between the booking appointment and surgery (26 days vs. 19 days; P = .001).

A multiple linear regression model showed that public hospital care was associated with longer intervals from diagnosis to surgery after adjustments for insurance status, age at diagnosis, cancer stage and number of preoperative visits (P < .001 for all).

In a subgroup analysis, Frey and colleagues found that patients with endometrial cancer experienced an average wait time of 70 days between diagnosis and surgery, compared with 36 days for patients treated in private hospitals (P < .001). A greater proportion of patients with endometrial cancer treated at public hospitals waited longer than 12 weeks for surgery (35% vs. 8%).

The researchers acknowledged limitations of their study, most of which were driven by the retrospective design. The researchers did not have access to information regarding the availability of operating time or patient surgical preferences. Further, they could not assess the patients’ perception of their preoperative experiences from the available data.

“We are using our patient navigators to try to help our patients create the most efficient schedule for the preoperative period,” Frey said. “We also found in a subgroup analysis that patients who were treated with chemotherapy or radiation before surgery had a much easier experience being ready for surgery. Early integration into the system is important. If the patient is already in the system with a medical doctor, the whole process is better for her.” – by Cameron Kelsall

For more information:

Melissa K. Frey, MD, can be reached at melissa.frey@nyumc.org.

Disclosure: The researchers report no relevant financial disclosures.

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