Reply to “Denominator-Based Studies Need Full Disclosure of the Origins of Patients Treated”

Excerpt

We thank Phillips and Asher for their comments on our article “Maximal-Effort Cytoreductive Surgery for Ovarian Cancer Patients with a High Tumor Burden: Variations in Practice and Impact on Outcome”, which was recently published in Annals of Surgical Oncology.1 They emphasize the importance of comparable populations, in this instance specifying the number of quaternary referrals in Centre A, which might have skewed the results. As stated, we only included patients presenting for the first time with stage III/IV ovarian cancer as we wanted to elucidate and identify the impact of the initial decision-making process with survival. National Health Service (NHS) quaternary referrals occur further down the line of a patients’ journey, when there are no more viable options in their local cancer centre and therefore the local team seeks advice in another expert centre. Thus, any such quaternary referral patients were automatically excluded from our analysis. We thank Dr Phillips for prompting us to make this clearer to our readers. The catchment referral areas, and therefore the origin of all our patients, are disclosed in Fig. 1. Even if we had included quaternary referrals to Centre A, the NHS local gynaecological cancer centres generally only refer challenging patients, for example those with significant comorbidities or borderline inoperability, to other expert centres. Such patients would be most likely to detrimentally affect the outcomes of Centre A.

…