Several years ago, Dr. Robert E. Bristow had a revelation while reviewing a study he and his colleagues conducted on 10,000 U.S. women with ovarian cancer. The study found that women who received treatment at high-volume hospitals (hospitals that treat at least 20 cases of ovarian cancer a year) survived longer than women cared for at low-volume hospitals.
Bristow — a UCI Health gynecological oncologist and a leading authority on ovarian cancer treatment — examined the data even more closely. He found that African-American women in general and women from lower socioeconomic levels were much more likely to die of the disease after adjusting for other variables.
“I was staring at this Excel spreadsheet and thought, ‘This is not right,’ ” Bristow recalls.
“Here in Orange County, a patient from Santa Ana who has safety-net insurance should have the same opportunity to survive her disease as a patient from Newport Coast. That is a basic truth.”
Providing high-quality care worldwide
Bristow, chair of the Department of Obstetrics & Gynecology at the UCI School of Medicine, now leads the charge to provide the highest-quality care — not just to UCI Health patients, but to women with ovarian cancer around the globe. He is the author of more than 200 scientific publications, five medical textbooks on ovarian cancer and two books for patients.
He also co-hosts an annual international medical conference on ovarian cancer to teach doctors the latest methods for fighting the disease. The conference location alternates between UCI and the United Kingdom. In the summer of 2016, he also hosted a course in the Philippines to teach ovarian cancer surgery to gynecologic oncologists in that region.
Improving ovarian cancer standards of care
Ovarian cancer is the fifth-leading cause of cancer deaths in women. Because it produces few overt symptoms early on, many women are diagnosed with late-stage cancer, which is difficult to cure.
In recent years, however, survival rates have nudged upward, even for women with advanced disease, due to better surgical techniques and new drugs.
Innovations include therapies that target the specific molecular mechanism that drives tumor growth and intraperitoneal chemotherapy (IP) — chemotherapy placed directly into the abdomen to destroy cancer cells hidden in abdominal tissue.
Leading the way in treatment
UCI Health leads the way in a variation of the procedure, hyperthermic intraperitoneal chemotherapy (HIPEC), which uses a heated chemotherapy agent to bathe the abdomen immediately after surgery to remove ovarian cancer tumors.
“The improvements in ovarian cancer have been incremental over time,” Bristow says. “The calculation of a woman’s chance of survival starts with whether she receives state-of-the-art treatment or not. That is the first stepping stone.”
But, he adds, “If a woman with stage III ovarian cancer gets very successful surgery and is afforded access to IP treatment, the median survival for those patients is 10 years, which is a crazy number. You never thought you would hear that number 10 years ago.”
Increasing survival rates
Such progress is heartening to Bristow, who initially chose to become an obstetrician and gynecologist because he enjoyed delivering babies. He grew up in the San Francisco Bay Area, son of a highly respected internist and researcher, Dr. Lonnie Bristow — who later became the first African-American president of the American Medical Association.
But when Bristow started his residency at Johns Hopkins Hospital in Baltimore, MD, his career took a sharp turn.
“I started my residency on July 1, 1991. By July 4th, I had decided oncology was what I needed to do,” he says. “The patients were so sick and they needed someone the most. At the end of the day, you have that feeling that you made a contribution to helping someone.”
Making a difference for all women
At UC Irvine Medical Center, which U.S. News & World Report ranked 20th in the nation for gynecology care, Bristow enjoys caring for patients, teaching and conducting research. He emphasizes providing each patient with personalized care that treats the whole person. At the same time, he remains keenly focused on the study of large populations of patients to bring to light disparities in care and lead to elevated treatment standards.
A few years ago, Bristow was attending the annual ovarian cancer conference held that year in the United Kingdom. He struck up a conversation over dinner with a conference attendee from northern Greece.
“This doctor said to me, ‘I want to thank you for writing your book on ovarian cancer surgery. That is our bible. I want you to know how much that impacts our patients,’ ” Bristow recalls.
“I would like to think that somewhere in northern Greece there is a 43-year-old mother of three kids who has survived ovarian cancer because she got the right surgery and right treatment because of a book we wrote, and because a doctor there read it and implemented the proper techniques,” he says. “It is beyond gratifying to know we are making a difference, not just for the patients sitting in our waiting rooms but for women halfway around the world.”