Efficacy of a Regional Network for Ovarian Cancer Care

Altena, Anne M. van; Akker, Petronella A.J. van den; Hullu, Joanne A. de; Ottevanger, Petronella B.; Aalders, Anette L.; Gerritse, Rene; Happel, Martin; Hoekstra, Marcel P.; Janssen, Mark-Jan; Samlal, Rahul A. K.; Smeets, Kirsten M.W.H.; Snijders, Marc P.L.M.; Vasmel, Maria J.; Vollebergh, Jos H.A.; Kiemeney, Lambertus A.; Massuger, Leon F.A.G.

doi:10.1097/aog.0b013e3182a054ee

Cited by 18 publications

(14 citation statements)

References 22 publications

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“…Treatment in referral hospitals and/or the attendance of a gynecologic oncologist at the time of surgery were associated with a high rate of optimal staging. These findings are in accordance with other studies [10,13,22,23,24]. …”

Section: Discussionsupporting

confidence: 94%

Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

Frielink¹,

Pijlman²,

Ezendam³

et al. 2016

Chemotherapy

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Background: Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. Methods: All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The percentage of patients that received adjuvant chemotherapy was determined as well as the comprehensiveness of staging and outcome. Results: Forty percent (54/135) of the patients with early-stage EOC received adjuvant chemotherapy. Treatment with adjuvant chemotherapy was associated with FIGO stage, clear-cell histology and nonoptimal staging. Optimal staging was achieved in 50%, and nonoptimal staging was associated with advanced age, comorbidity and treatment in a non-referral hospital. Overall, there was no difference in outcome between patients with and without adjuvant chemotherapy. Yet, in grade 3 tumors, adjuvant chemotherapy seems beneficial. Conclusions: Selective treatment of patients with early-stage EOC might reduce adjuvant chemotherapy without compromising outcome.

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Section: Discussionsupporting

confidence: 94%

Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

Frielink¹,

Pijlman²,

Ezendam³

et al. 2016

Chemotherapy

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“…24,25 Surgeons from gynecological units seemed to be more likely to adhere to guidelines than general surgeons. This result reflects what was observed in the Netherlands by van Altena et al, 26 where a collaboration among surgeons from the university center and community hospitals improved surgical outcomes. Compared with surgery, chemotherapy was more often adherent to guidelines in regard to both the treatment scheme and the sequencing with surgery.…”

Section: Discussionsupporting

confidence: 89%

Is Ovarian Cancer Being Managed According to Clinical Guidelines? Evidence From a Population-Based Clinical Audit

Sobrero

Pagano

Piovano

et al. 2016

International Journal of Gynecological Cancer

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“…The current data showing an association between NCI-CCC status and improved adherence to treatment guidelines and survival may have important health policy and administration implications regarding concentration of ovarian cancer services as a mechanism to improve outcomes for all women with ovarian cancer as well as effectively reduce racial and SES-based disparities in survival. 34 Notably, our data indicate that even among the most challenging lower socioeconomic populations (SES-1 through SES-3), the survival advantage associated with NCI-CCC care was maintained proportionate to the general population.…”

Section: Discussionmentioning

confidence: 64%

Impact of National Cancer Institute Comprehensive Cancer Centers on Ovarian Cancer Treatment and Survival

Bristow

Chang

Ziogas

et al. 2015

Journal of the American College of Surgeons

102

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BACKGROUND The regional impact of care at a National Cancer Institute Comprehensive Cancer Center (NCI-CCC) on adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines and survival is unclear. STUDY DESIGN We performed a retrospective population-based study of consecutive patients diagnosed with epithelial ovarian cancer between January 1, 1996 and December 31, 2006 in southern California. Patients were stratified according to care at an NCI-CCC (n = 5), non-NCI high-volume hospital (≥10 cases/year, HVH, n = 29), or low-volume hospital (<10 cases/year, LVH, n = 158). Multivariable logistic regression and Cox-proportional hazards models were used to examine the effect of NCI-CCC status on treatment guideline adherence and ovarian cancer-specific survival. RESULTS A total of 9,933 patients were identified (stage I, 22.8%; stage II, 7.9%; stage III, 45.1%; stage IV, 24.2%), and 8.1% of patients were treated at NCI-CCCs. Overall, 35.7% of patients received NCCN guideline adherent care, and NCI-CCC status (odds ratio [OR] 1.00) was an independent predictor of adherence to treatment guidelines compared with HVHs (OR 0.83, 95% CI 0.70 to 0.99) and LVHs (OR 0.56, 95% CI 0.47 to 0.67). The median ovarian cancer-specific survivals according to hospital type were: NCI-CCC 77.9 (95% CI 61.4 to 92.9) months, HVH 51.9 (95% CI 49.2 to 55.7) months, and LVH 43.4 (95% CI 39.9 to 47.2) months (p < 0.0001). National Cancer Institute Comprehensive Cancer Center status (hazard ratio [HR] 1.00) was a statistically significant and independent predictor of improved survival compared with HVH (HR 1.18, 95% CI 1.04 to 1.33) and LVH (HR 1.30, 95% CI 1.15 to 1.47). CONCLUSIONS National Cancer Institute Comprehensive Cancer Center status is an independent predictor of adherence to ovarian cancer treatment guidelines and improved ovarian cancer-specific survival. These data validate NCI-CCC status as a structural health care characteristic correlated with superior ovarian cancer quality measure performance. Increased access to NCI-CCCs through regional concentration of care may be a mechanism to improve clinical outcomes.

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Efficacy of a Regional Network for Ovarian Cancer Care

Abstract: II.

Cited by 18 publications

References 22 publications

Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

Is Ovarian Cancer Being Managed According to Clinical Guidelines? Evidence From a Population-Based Clinical Audit

Impact of National Cancer Institute Comprehensive Cancer Centers on Ovarian Cancer Treatment and Survival

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