Improving the quality of care for patients with advanced epithelial ovarian cancer: Program components, implementation barriers, and recommendations

Abstract

The high lethality of ovarian cancer in the United States and associated complexities of the patient journey across the cancer care continuum warrant an assessment of current practices and barriers to quality care in the United States. The objectives of this study were to identify and assess key components in the provision of high-quality care delivery for patients with ovarian cancer, identify challenges in the implementation of best practices, and develop corresponding quality-related recommendations to guide multidisciplinary ovarian cancer programs and practices. This multiphase ovarian cancer quality-care initiative was guided by a multidisciplinary expert steering committee, including gynecologic oncologists, pathologists, a genetic counselor, a nurse navigator, social workers, and cancer center administrators. Key partnerships were also established. A collaborative approach was adopted to develop comprehensive recommendations by identifying ideal quality-of-care program components in advanced epithelial ovarian cancer management. The core program components included: care coordination and patient education, prevention and screening, diagnosis and initial management, treatment planning, disease surveillance, equity in care, and quality of life. Quality-directed recommendations were developed across 7 core program components, with a focus on ensuring high-quality ovarian cancer care delivery for patients through improved patient education and engagement by addressing unmet medical and supportive care needs. Implementation challenges were described, and key recommendations to overcome barriers were provided. The recommendations emerging from this initiative can serve as a comprehensive resource guide for multidisciplinary cancer practices, providers, and other stakeholders working to provide quality-directed cancer care for patients diagnosed with ovarian cancer and their families.

Ovarian cancer

“…Patients with ovarian cancer may receive a variety of chemotherapy and targeted therapy agents (see Chemotherapy and targeted therapy). Surgical recovery 1,4,10,27,[37][38][39][40][41] Cytoreduction and simultaneous resection of other body tissues and organs may take 6 to 12 hours. The patient is hospitalized from 3 to 7 days.…”

“…Infection 1,4,10,26,27,[37][38][39][40][41] Patients are at increased risk for infection related to chemotherapy and surgery. The infection risk is greatest when they reach their absolute neutrophil count (ANC) nadir, 7 to 14 days after a chemotherapy cycle.…”

“…Nutrition and fluids 1,4,10,27,[37][38][39][40][41] The patient's nutritional pattern, caloric requirements, and body weight must be assessed. Antiemetic medications may be needed after surgery and during chemotherapy.…”

“…Pain 1,4,10,27,[37][38][39][40][41] Encourage the patient to describe the location and severity of pain on a scale from 0 (no pain) to 10 (very severe). Mindfulness-based stress reduction (MBSR) activities such as rest, music, and deep breathing are helpful.…”

European cancer mortality predictions for the year 2022 with focus on ovarian cancer

“…22,23 Poly(ADP-ribose) polymerase (PARP) inhibitors have greater efficacy in subpopulations with BRCA mutations or other conditions leading to homologous recombination deficiency. [23][24][25] Stomach cancer is the site with the longest and most consistent declines, particularly in the UK with a predicted 30% fall in women since 2016. This is largely attributable to a reduced prevalence in Helicobacter pylori infection, 26 together with some contribution of improved lifestyle conditions, such as better food conservation through refrigeration and a reduction in the consumption of food preserved through salting, smoking and pickling in subsequent generations.…”