Abstract
ABSTRACT
Introduction
Rare cancers such as gestational trophoblastic neoplasia (GTN) should be managed in specialized centers, allowing for multidisciplinary team input, expert pathology review, consensus‐based treatment and surveillance pathways, and improved patient survival and patient‐reported outcomes.
Methods
This retrospective study assessed the impact of centralized care implementation at a tertiary academic women's hospital on patients diagnosed and treated with GTN between 2021 and 2024 in Western Australia. Clinical outcomes compared 2 years pre‐centralization (2021–2022) and 2 years post‐centralization (2023–2024). The post‐centralized patient experience was assessed via surveys.
Results
A total of 36 patients with GTN were included: 20 pre‐centralization and 16 post‐centralization. Over the 4‐year study period, 32 patients were categorized as low‐risk, two were high‐risk, and two had high‐risk histology that precluded prognostic risk assignment. Centralization of care led to an improvement in identifying those who met the diagnostic criteria for GTN (65% vs. 100%,
p
= 0.011) and subsequent appropriate chemotherapeutic intervention, as well as better accuracy in the assignment of International Federation of Gynecology and Obstetrics (FIGO) stage (41% vs. 89%) and World Health Organization (WHO) prognostic score (46% vs. 82%). Methotrexate was favored as first‐line chemotherapy for low‐risk disease in both groups. There have been no relapses or deaths in either group to date. Centralization of care led to improved contraceptive counseling documentation (65% vs. 87.5%,
p
= 0.026) yet similar pregnancy rates. The patient experience with centralized care was positive.
Conclusion
Although study numbers are small, this study supports the establishment of centralized centers for rare trophoblastic diseases.