A recent study showed most women with ovarian cancer do not receive appropriate care, but medical specialists here say women in Hawaii see fewer roadblocks to getting the treatment they need for the disease.
The study, which found that only about a third of patients receive care that meets National Comprehensive Cancer Network guidelines, has generated nationwide attention. It was presented at a March meeting of the Society of Gynecologic Oncology in Los Angeles and publicized in a March 11 story in the quoting its lead author, Dr. Robert Bristow, director of gynecologic oncology at the University of California, Irvine.
The results of the study, which were based on medical records for more than 13,000 California women diagnosed with ovarian cancer from 1999 to 2006, mirrored results from similar studies. Cancer specialists around the country say women receive poor care because they don’t see the doctors most qualified to treat them.
Dr. Michael Carney, medical director of the Women’s Cancer Center at Kapiolani Medical Center for Women & Children, said he doesn’t see that as a problem in the islands.
"I think people feel isolated sometimes and don’t know if we get good care here," said Carney, who is also an associate clinical professor at the University of Hawaii Cancer Center. "Fortunately, there is really good care here. Patients have really good opportunities for appropriate treatment for ovarian cancer through a specialist.
"It’s a small state, and most of our referrals come from the OB/GYN docs or the family medicine docs, every once in a while the emergency room docs. But we all kind of know each other, and there are good lines of communication. I think people are pretty quick to refer to specialty care."
According to the Centers for Disease Control and Prevention, Hawaii’s age-adjusted incidence of ovarian cancer was 11.4 per 100,000 people in 2009, the last year data were available. That put Hawaii 28th out of the 50 states and the District of Columbia, excluding Wisconsin, which did not want its 2009 data included. The national average is 11.8 cases per 100,000.
However, age-adjusted mortality was just 5.7 per 100,000 in Hawaii, the second-lowest death rate among the states studied and the District of Columbia. The national average is 7.8 ovarian cancer deaths per 100,000. Wisconsin was included in this data set.
Dr. Robert Kim, a staff physician at University Women’s Health Specialists and assistant professor of gynecologic oncology at the UH-Manoa John A. Burns School of Medicine, said Hawaii’s lower death rate can be attributed in part to easy access to gynecologic oncologists who can recommend and provide the most appropriate individualized treatments.
However, he added, other factors such as genetic predisposition of the local population and the racial diversity of the islands could play a role as well.
Kim also said the study might be a little misleading because it looks at a specific set of criteria for what the best care and treatment is, and fails to look at individual situations and decisions.
"It’s hard to break down data on a large scale, hard to really figure out the meat between each patient," he said. "And what’s not being elucidated is patient preference. … In Hawaii I’ve seen a good number of patients looking for alternative therapies and naturopathic treatment. It’s not right or wrong. It might go against more evidence-based medicine, but they’re adults and make their own choices. We have to abide by their autonomy."
According to the American Cancer Society, more than 22,000 women will be diagnosed with ovarian cancer this year, and more than 14,000 will die from it. Although it is not among the most common cancers, it is the fifth-leading cause of cancer deaths in women and is the deadliest gynecologic cancer. Carney said this is largely because ovarian cancer lacks a specific screening procedure, often resulting in late detection.
"Cervical cancer — we have the Pap smear; breast cancer — there’s the mammogram; colon cancer — we have the colonoscopy; skin cancer — we have thorough skin exams; but some cancers we just don’t have any good screening mechanisms for them," he said. "Ovarian cancer … is not as easily detected early, and so it grows. There are some early, subtle symptoms that most people just kind of dismiss."
Nuuanu resident Eileen Yoshinaka, 65, was diagnosed with Stage 3-C ovarian cancer in September 2010 after she was referred to Carney by her gynecologist. She underwent surgery the following month, which included a hysterectomy and having her ovaries and appendix removed. She endured months of chemotherapy and went into remission in 2011.
Last July she relapsed and resumed chemotherapy.
Despite that, Yoshinaka said she has received the best care possible because she’s seeing a specialist.
"No doubt everything that can be done is being done," she said. "I read the story in the paper and I couldn’t believe what I was reading. I thought, ‘In this day and age, people aren’t seeking a doctor with a specialty?’ … There’s no doubt in my mind that I am getting the very best care because my doctors are trained and have a lot of experience dealing with my specific situation."