Treating vulvar cancer in the new millennium: Are patients receiving optimal care?

OBJECTIVE: The purpose of our study is to describe patterns of care of invasive vulvar carcinoma in the province of Ontario, Canada. Our ultimate goal is to improve vulvar cancer care by understanding variations in care and their impact on outcome. In this pilot study, we specifically evaluate the use of groin node dissection (GND). METHODS: The provincial cancer registry was used to identify incident cases of vulvar carcinoma diagnosed between 1994 and 2003. These cases were linked to physician billings claims and hospital discharge records to identify treatment given in the first year after diagnosis. RESULTS: The cohort included 978 women with vulvar carcinoma. 85% had at least one surgical procedure. 62% of these had a GND. GND was more likely in those who were treated by a gynecologic oncologist or who had less co-morbid illness. Approximately 25% received radiotherapy. CONCLUSION: The rate of GND appears to be low. As proper management of the groins is critical for most patients with vulvar cancer, this observation raises concerns about the quality of treatment received by patients with vulvar carcinoma. Further investigation is required to verify the observations made in this hypothesis generating study.