Pay per view.

Top Line: In 2018, the LACC trial surprisingly showed worse survival when minimally invasive surgical techniques were used for hysterectomy for cervical cancer.

The Study: A more recent study analyzed a national case database and found that the use of minimally invasive surgery for cervical cancer significantly decreased after publication of LACC (58% → 43%). But that decrease appeared to vary by practice type with an odds ratio for minimally invasive surgery use of 0.27 in academic centers compared to 0.81 in non-academic centers. Why the slow change in non-academic centers? One speculative reason that resonates here at QuadShot is access to scientific literature. There is no question the LACC trial was a watershed moment for the surgical management of cervical cancer. And while there was a stark difference in how quickly the use of minimally invasive surgery dropped among academic versus non-academic centers, there’s also a stark difference in how information is disseminated inside versus outside the academic world. By now the LACC paper is free to everyone, but many papers (including the paper discussed here) remain behind a paywall for a year or more after initial publication. We’re not trying to imply any causation here, but we would like to raise awareness about how hard it can be to access scientific publications without the bargaining power of academic institutions. Simply put, if we want practice changing studies to actually change practice, perhaps we should make them more widely available to all healthcare providers. End rant.

TBL: Following publication of the LACC trial, the use of minimally invasive surgery dropped faster among academic versus non-academic centers—but you'll have to pay to read more about that. | Lewicki, N Engl J Med 2021


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