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The treatment of gynaecological malignancy in a general public hospital
P T Grant1, N A Beischer, R S Planner
1University of Melbourne, Department of Obstetrics and Gynaecology, Austin Hospital, Vic.
Objective:
To assess the adequacy of treatment of gynaecological cancer in a public hospital and to determine the influence of referral patterns on patient outcome.
Design:
A retrospective analysis of clinical histories.
Setting:
A tertiary-level general public hospital.
Patients:
89 patients admitted between 1 January 1979 and 31 December 1987 for primary treatment of a gynaecological malignancy.
Main Outcome Measures:
The primary study parameter was patient survival. During data analysis, the study parameters were altered to include the adequacy of initial surgery and survival time in relation to the involvement of the Gynaecology Unit.
Results:
Initial presenting symptoms had a major influence on the referral patterns of patients with a gynaecological malignancy. All patients who presented with abnormal vaginal bleeding were managed by the Gynaecology Unit. Patients with ovarian cancer who presented with non-specific abdominal symptoms and ascites were often managed by other units. There was a statistically significant difference in the adequacy of initial surgery depending on whether the patient was managed by the Gynaecology or the Surgical Unit (P < 0.05). The median survival time of patients managed by the Gynaecology Unit was 20 months; this was considerably longer than the figure of 14 months for other units (P < 0.05).
Conclusions:
Patients with ovarian cancer who are managed by a specialised gynaecology unit are more likely to have adequate initial surgery and a longer median survival time. Female patients presenting with non-specific abdominal symptoms, ascites and other signs of intra-abdominal malignancy should be reviewed by a gynaecology unit before initial surgery.