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

Sobrero, Simona; Pagano, Eva; Piovano, Elisa; Bono, Lorenzo; Ceccarelli, Manuela; Ferrero, Annamaria; Macchi, Chiara; Mistrangelo, Marinella; Patriarca, S; Tripodi, Elisa; Roberto, Zanetti; Bertetto, Oscar; Ciccone, Giovannino; Zola, Paolo

doi:10.1097/igc.0000000000000830

Cited by 6 publications

(6 citation statements)

References 30 publications

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“…Knowing the real world is essential to start promoting changes in the treatment of EOC patients. Despite the fact that since 2004 the Italian national guidelines program has supported centralization for EOC patients 55 , several authors over time have highlighted a lack of centralization 56 which still seems to persist (Table 1 ) and that likely reflects into a suboptimal treatment of affected patients. The national health system, the scientific societies and first of all the individual specialists (gynecologists, oncologists, general surgeons, general practitioners) should guarantee all patients the most appropriate treatments by directing them to the centers with greater competence.…”

Section: Discussionmentioning

confidence: 99%

An Italian National Survey on Ovarian Cancer Treatment at first diagnosis. There's None so Deaf as those who will not Hear

Mandato¹,

Torricelli²,

Uccella³

et al. 2021

J. Cancer

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Objective: Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, crucial prognostic factors are no gross residual disease and centralization of cases. To evaluate the centralization of EOC patients, we report the results of a survey that shows the daily management of EOC patients in Italy. Methods: A 49-items electronic unblinded survey assessing demographics, practice characteristics, current opinions and approach to managing advanced EOC at first diagnosis was sent both to general gynecologists (GG) and gynecologic oncologists (GO). Differences in frequency distribution of answers between gynecologists with different expertise were evaluated using Fisher exact test. Multivariable analyses were performed applying generalized linear models. Results: 84/192 (44%) GG and 108/192 (56%) GO from all Italian regions answered to our survey. GOs declared to perform fertility sparing surgery in early EOC more frequently than GG (p=0.002). GOs can perform a frozen section and have both a gynecopathologist and a dedicated general surgeon. 89% of GOs consider as “optimal debulking” no gross residual disease and 81% achieve this at upfront cytoreduction in more than 40% of patients. Use of neoadjuvant chemotherapy decreases in higher volume centers (p<0.001) while it is lower in the group of GOs than in the GGs group (p<0.001). Conclusions: EOC patients are still treated by GGs. GOs perform more upfront surgery and achieve optimal debulking in a greater percentage of patients than GGs. In Italy an adequate centralization of cases has not yet been achieved, and this may have detrimental effects on the quality of treatment.

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Section: Discussionmentioning

confidence: 99%

An Italian National Survey on Ovarian Cancer Treatment at first diagnosis. There's None so Deaf as those who will not Hear

Mandato¹,

Torricelli²,

Uccella³

et al. 2021

J. Cancer

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“…Of the 11 studies grouped under guideline adherence and deviation, 8 utilised the NCCN ovarian cancer guidelines as the comparator guideline, with 3 using their own local or national guidelines [3,[17][18][19][20][21][22][23][24][25][26]. These studies collectively indicated variation in adherence to guidelines for both surgical staging and receipt of chemotherapy.…”

Section: Guideline Adherence and Deviationmentioning

confidence: 99%

Enhancing ovarian cancer care: a systematic review of guideline adherence and clinical variation

White¹,

Seale²,

Harrison³

2019

BMC Public Health

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Background: Clinical variation in ovarian cancer care has been reported internationally. Using Wennberg's classification of clinical variation as effective care we can conceptualise variation through deviation from clinical guidelines. The aim of this review was to address knowledge gaps in the effectiveness of attempts to reduce unwarranted clinical variation through addressing the following questions: What is the evidence of guideline adherence in ovarian cancer and its deviation?; what are the key factors associated with variation in guideline adherence in ovarian cancer care?; and what quality improvement approaches have been used and what is the evidence of their effectiveness in enhancing guideline adherence in ovarian cancer care?. Methods: Keywords and synonyms for the major concepts of ovarian cancer, guideline adherence and safety were developed and combined to form the search strategy. Systematic searches of four electronic databases were undertaken of publications from January 2007 to November 2018. Retrieved articles were assessed against the eligibility criteria to determine those for inclusion. Results: Thirty-two papers were included in the review with three broad groupings identified: adherence to and deviation from guidelines (either local, national or international guidelines); factors impacting guidelines adherence; and quality improvement approaches. Conclusions: Unwarranted clinical variation may be used as a marker for the effectiveness of a health system, based on the outcome of this systematic review. This review found that the implementation of quality indicators through a formal quality improvement program lead to improvements in guideline adherent care. Further research on outcomes of implementing quality improvement programs in ovarian cancer care will improve the ability to implement centralised care and further identify factors that to improve outcomes in ovarian cancer care.

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“…They can highlight potential quality concerns, identify areas that need further study and investigation, track changes over time, and enable physicians to compare their practices with the guidelines and with each other, in order to strive for optimal health care [3,4]. Recent literature shows that less than 50% of patients suffering from ovarian cancer in Europe are treated according to the guidelines and that there is a correlation between treatment adherent to the guidelines and survival [5]. This is a striking example demonstrating that there is a high need for quality control and benchmarking in our health care systems [4].…”

Section: Introductionmentioning

confidence: 99%

“…Although international organizations such as ESMO and ESGO have provided guidelines on the treatment of gynaecological cancers, up to now no agreement has been reached on the proper QI’s which could be used to measure and benchmark the quality of the provided care [ 7 , 13 – 15 ]. Therefore, we decided to perform an online survey for specialists involved in the treatment of patients with endometrial, cervical and ovarian cancer to question the acceptability and practicability in daily practice of the QI’s which were distilled out of our literature search [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Acceptability of quality indicators for the management of endometrial, cervical and ovarian cancer: results of an online survey

et al. 2020

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Background: Measuring quality indicators (QI's) is a tool to improve the quality of care. The aim of this study was to evaluate the acceptability of 36 QI's, defined after a literature search for the management of endometrial, cervical and ovarian cancer. Relevant specialists in the field of interest were surveyed. Methods: To quantify the opinions of these specialists, an online survey was sent out via mailing to members of gynaecological or oncological societies. The relevance of each QI was questioned on a scale from one to five (1 = irrelevant, 2 = less relevant, 3 = no opinion/neutral, 4 = relevant, 5 = very relevant). If a QI received a score of 4 or 5 in 65% or more of the answers, we state that the respondents consider this QI to be sufficiently relevant to use in daily practice. Results: The survey was visited 238 times and resulted in 53 complete responses (29 Belgian, 24 other European countries). The majority of the specialists were gynaecologists (45%). Five of the 36 QI's (13,9%) did not reach the cutoff of 65%: referral to a tertiary center, preoperative staging of endometrial cancer by MRI, preoperative staging of cervical cancer by positron-emission tomography, incorporation of intracavitary brachytherapy in the treatment of cervical cancer, reporting ASA and WHO score for each patient. After removing the 5 QI's that were not considered as relevant by the specialists and 3 additional 3 QI's that we were considered to be superfluous, we obtained an optimized QI list. Conclusion: As QI's gain importance in gynecological oncology, their use can only be of value if they are universally interpreted in the same manner. We propose an optimized list of 28 QI's for the management of endometrial, cervical and ovarian cancer which responders of our survey found relevant. Further validation is needed to finalize and define a set of QI's that can be used in future studies, audits and benchmarking.

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

Abstract: Results support the need to reorganize the clinical pathway of patients with OC in the Piedmont Region and the need for better adherence to current guidelines.

Cited by 6 publications

References 30 publications

An Italian National Survey on Ovarian Cancer Treatment at first diagnosis. There's None so Deaf as those who will not Hear

An Italian National Survey on Ovarian Cancer Treatment at first diagnosis. There's None so Deaf as those who will not Hear

Enhancing ovarian cancer care: a systematic review of guideline adherence and clinical variation

Acceptability of quality indicators for the management of endometrial, cervical and ovarian cancer: results of an online survey

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