Examining Referrals and Cancer Care Costs

In the opening plenary session of the second day of the Society of Gynecologic Oncologists meeting, Ware and associates described a multi-institutional experience that examined the utility of the American Society of Obstetricians referral guidelines for a pelvic mass. The report concluded that referral for advanced disease was quite good, occurring in more than 90% of documented cases, but the sensitivity of the guidelines for a malignancy in a pre-menopausal woman was only approximately 50%. Despite the conclusion of this paper challenging the success of the current established guidelines, the discussant for this presentation make the provocative suggestion that these results were actually reassuring because the large majority of patients with extensive disease who were most likely to benefit from the particular surgical expertise of a gynecologic oncologist were appropriately identified. In contrast, patients who might quite appropriately be surgically managed by a non-gynecologic cancer specialist were the group more likely to remain under the care of this group of physicians.

Cohn and colleagues, using theoretical data from an ongoing Gynecologic Oncology Group trial examining the potential utility associated with adding bevacizumab to primary carboplatin plus paclitaxel in advanced stage ovarian cancer, proposed a provocative model that would permit clinical investigators, governmental policy makers, and payers of healthcare services to explore the cost-effectiveness of any new anti-neoplastic agent being proposed for introduction into clinical practice. The investigators noted that either by reducing the cost on an investigational agent or by improving the clinical outcomes (eg, greater difference in progression-free survival between the treatment arms) the experimental agent may be able to become acceptably cost-effective.

Finally, Barnes and colleagues presented a sobering analysis of the institutional costs associated with the conduct of high-quality, government-sponsored, cooperative group research in the gynecologic cancer arena, noting that the current funding provided by the National Cancer Institute is far from adequate to cover the actual costs associated with this critically important research-related effort (eg, nursing, data-management, regulatory document submission and monitoring). The question was further raised regarding the future of cooperative group efforts in the absence of essential non-institutional funding support.