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Lignes directrices et conseils

Organizational Guideline for Gynecologic Oncology Services in Ontario

ID: 4-11 juin 2013
Type of Content: Guidelines & Advice, Clinical, Health System, Models of Care
Document Status: In-Review
Authors:
M. Fung-Kee-Fung, E.B. Kennedy, J. Biagi, T. Colgan, D. D’Souza, L. Elit, A. Hunter, J. Irish, R. McLeod, B. Rosen , Gynecologic Oncology Organizational Guideline Expert Panel

Patient Population

Women in Ontario who have been diagnosed with gynecologic cancer or have an ovarian mass with Risk of Malignancy Index (RMI) >200. The scope does not include the following non-invasive cases:

  • Cervical intraepithelial neoplasia & carcinoma in situ (<Stage T1a1);
  • Vaginal intraepithelial neoplasia;
  • Vulvar intraepithelial neoplasia;
  • Ovarian masses with an RMI score of less than 200, as these cases are less likely to be invasive;
  • Low-risk gestational trophoblastic neoplasia (GTN) that resolves spontaneously.

Intended Guideline Users

Ontario policy makers and clinicians involved in the care of gynecologic cancer patients.

Research Question(s)

  1. Does treatment by a gynecologic oncologist result in better outcomes than treatment by a gynecologist (GYN) or general surgeon (GS)?
  2. Are there better outcomes for patients with gynecologic cancer treated in designated centres compared to non-designated centres?
  3. Is there a volume-outcome relationship between number of procedures by a physician/hospital and patient surgical or survival outcomes?
  4. In addition, the Gynecologic Oncology Organizational Guideline Development Group (the Guideline Development Group) agreed to use the evidentiary base generated by the research questions above to provide consensus-based guidance regarding implementation of the optimal system of organization for gynecologic oncology in Ontario.

Questions related to implementation/organization include:

  1. How will services be regionally organized? Will specialized gynecologic oncology centres be designated?
  2. If designated centres are recommended:
    • What is the optimal relationship or network of care between designated and nondesignated centres?
    • What are the human and physical resources requirements of a designated (specialized) centre?

The general consensus at this time is that multidisciplinary care is the standard for all cancer types, and Cancer Care Ontario supports the use of regularly scheduled multidisciplinary cancer conferences (MCCs) to prospectively review individual cancer patients and make recommendations on management.

The following questions specific to gynecologic oncology multidisciplinary teams (MDTs) were also asked by the Guideline Development Group:

  1. What are the recommended staff requirements for a gynecologic oncology MDT?
  2. What expertise/formal training is required by the members of the MDT?
pdf download Summary (PDF) (396.71 Ko)