At the 2013 annual meeting on Women’s Cancer by The Society of Gynecologic Oncology (March 9 2012 – Los Angeles) Dr. Robert Bristow, the director of Gynecologic Oncology at the University of California – Irvine presented a retrospective review of the medical records of 13,321 women with ovarian cancer, diagnosed from 1999 through 2006 in California. The study determined that only 37% of the care provided to this cohort adhered to the guidelines set forth by the National Comprehensive Cancer Network setting forth specific surgical procedures and chemotherapy. In women that received the specified protocol, 35% survived at least five years where as only 25% of those survived, where the guidelines were not followed.
More than 80% of the woman, as reported in the New York Times today, where cared for by what was labeled as “low volume” surgeons, who operated on 10 or fewer cases a year and hospitals with 20 or fewer cases per year.
The ethical and moral issues here arise out of the legal requirements of obtaining an informed consent. Consent is only deemed “informed” if it provides all material information – information that would be deemed important by the average reasonable person.
It is, therefore, legally required and ethically and morally mandated that patients be told by the physician that:
“I do not follow the medical and surgical guidelines recommended by the National Comprehensive Cancer Network that have a statistically significant better outcome in terms of life expectancy. Do you want me to treat your ovarian cancer or refer you to a physicians who follows these other guidelines?”
Not a likely scenario. Any physicians caring for the patients with ovarian cancer are required to keep abreast be aware of all up-to-date medical literature, and follow best practices and evidenced based medical guidelines for this devastating disease. Failure to provide such information to every similarly situated patient would be unethical, immoral, and a breach of the standard of care. That may also go further into the realm of fraud if it could be shown that the physician knew of this information, but failed to disclose it for purposes of his or her own financial gain, or the gain of the hospital.