A Better Way

A cancer procedure has better outcomes — so why isn't everyone using it?

By Mayo Clinic Staff

Researchers from a national group including Sean C. Dowdy, M.D., discovered the U.S. health care system would have averted 2,300 complications among 32,000 cases if minimally invasive surgery had been used to treat endometrial cancer.

As she sips warm tomato basil soup, Carol Ostby can't believe that 24 hours ago doctors were prepping her for a hysterectomy to combat her shocking diagnosis — endometrial cancer.

Now, Carol is with her daughter enjoying lunch in Rochester, Minnesota. And, with chocolate ice cream cones in hand, the duo continues the journey home.

The key to Carol's quick recovery was the type of surgery her care team at Mayo Clinic used — a minimally invasive hysterectomy. At Mayo Clinic, physicians use laparoscopy or robotics to treat 90 percent of patients like Carol who have early-stage endometrial cancer.

However, there is a significant gap in its use across the country, greatly affecting patient care and cost.

But for Sean C. Dowdy, M.D., the bottom line isn't just financial. As a professor in Mayo Clinic Cancer Center, he joined the leadership team for the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, a research center that uses data-driven science to improve the quality of care patients receive, including surgery for women with gynecological cancers.

"Minimally invasive surgery results in reduced hospital stay, reduced complications, faster recovery, faster return to work and improved quality of life compared with laparotomy (open surgery)," Dr. Dowdy says.

"The patient-reported outcomes are also much better."

With this in mind, Dr. Dowdy joined forces with researchers at Johns Hopkins University and the University of California to answer a disturbing question: If minimally invasive surgery is recommended by the Society of Gynecologic Oncology and the Commission on Cancer for stage I-III endometrial cancer, then why don't all surgeons employ this technique?

The team examined data from more than 32,000 patients at more than 1,000 U.S. hospitals between 2007 and 2013. And while they expected to see that the use of minimally invasive surgery for the treatment of endometrial cancer varies, they were surprised to find that surgeons only used the minimally invasive procedure in less than half of these patients.

Dr. Dowdy and colleagues concluded that if minimally invasive surgery had been used in 80 percent of those patients instead of roughly 50 percent, it would have averted 2,300 complications and saved the U.S. health care system approximately $19 million. Dr. Dowdy and his team are now focusing on the reason for this disparity. He suspects some of it is due to lack of awareness.

"We have to do a better job of educating our patients that minimally invasive surgery might be an option for those with endometrial cancer," says Dr. Dowdy, who recently partnered with the Society for Gynecologic Oncology to introduce minimally invasive surgery as a national quality measure for patients with endometrial cancer. "But not only do we need to educate our patients, we as physicians need to hold ourselves accountable.

"One of the biggest challenges we have today in health care is to understand how to help physicians evolve more quickly as new medical techniques become available."

Help Mayo Clinic meet the challenges present in the national health care system by contributing to the Mayo Clinic Kern Center for the Science of Health Care Delivery today.