Setting the bar: compliance with ovarian cancer quality indicators at a National Cancer Institute-designated Comprehensive Cancer Center

Liang, Margaret; ElNaggar, Adam C.; Nekkanti, Silpa; O’Malley, David M.; Hade, Erinn M.; Fowler, Jeffrey M.; Salani, Ritu; Backes, Floor J.; Cohn, David E.

doi:10.1016/j.ygyno.2015.07.094

Cited by 11 publications

(22 citation statements)

References 18 publications

(16 reference statements)

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“…The NCI currently recommends strongly considering IV/IP chemotherapy in optimally cytoreduced stage III ovarian, fallopian tube, and primary peritoneal cancer (5). Despite these recommendations, this regimen is not widely used (6–9). A recent report showed that the overall rate of IV/IP chemotherapy use at six NCCN cancer centers after the NCI’s recommendation was released in 2006 was only 47%.…”

Section: Discussionmentioning

confidence: 99%

“…A recent report revealed that IV/IP chemotherapy use in eligible patients ranges from 4–67% in six National Comprehensive Cancer Network (NCCN) sites, where, presumably, there should have been no logistical barriers to IP chemotherapy administration (6). Other reports confirm the poor utilization of this therapy despite the NCI recommendation (7–9). The lay media has also reported on this discrepancy, exposing an opportunity for quality improvement (10).…”

Section: Introductionmentioning

confidence: 93%

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Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center

Schlappe

Mueller

Zivanovic

et al. 2016

Gynecologic Oncology

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Objective Studies have demonstrated improved ovarian cancer survival with the administration of a combination of intravenous (IV) and intraperitoneal (IP) chemotherapy following optimal cytoreduction. Despite this, IV/IP chemotherapy is not uniformly used. In this retrospective cohort study, we assessed the documented reasons for giving IV-only chemotherapy. Methods All patients who had optimal primary cytoreductive surgery for stage III ovarian, fallopian tube, or primary peritoneal carcinoma, met eligibility criteria for GOG-172, and received primary chemotherapy at our institution between 2006 and 2013 were identified. Patients who received at least one cycle of adjuvant IV/IP therapy were included in the IP group. Patient characteristics, treatment information, and reason cited for not administering IP therapy were collected. Results Of the patients evaluated, 330 met inclusion criteria. The majority (n=261, 79%) received at least one IV/IP cycle (median, 6; range, 1–6), and 62% completed 6 cycles. The most common reason for giving IV-only therapy was postoperative status (i.e., delayed wound healing, performance status), accounting for 18 (26%) of the 69 IV-only patients (5% of the entire cohort). Other cited reasons were baseline comorbidities (15%) and IP port complications (12%). Receipt of ≥1 cycle of IP chemotherapy (HR 0.51; 95% CI, 0.32–0.80) and no gross residual disease (HR 0.47; 95% CI, 0.31–0.71) were associated with improved overall survival. Conclusion Potentially modifiable factors identified as leading to the use of IV-only chemotherapy were postoperative status and IP port complications, which if altered, could potentially lead to increased IP chemotherapy use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center

Schlappe

Mueller

Zivanovic

et al. 2016

Gynecologic Oncology

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“…1 Flow diagram of selection process. Flow diagram outlining the selection process of studies found in the initial search and how studies were excluded, leading to the final 32 studies included in the systematic review studies) [27][28][29][30][31][32][33][34][35][36][37][38] and 3) quality improvement approaches (9 studies) [39][40][41][42][43][44][45][46][47].…”

Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

“…Three studies reported on the impact of quality improvement programs on improving outcomes in ovarian cancer through increasing adherence to clinical guidelines, resulting in a reduction of unwarranted clinical variation [39,41,42]. The final study reported on one hospital's compliance with Society of Gynecologic Oncology quality indicators [43]. Five studies reporting on the development of quality indicators all had similarities in the indicators developed, with a focus on rates of complete surgical resection [40,[44][45][46][47].…”

Section: Quality Improvement Approachesmentioning

confidence: 99%

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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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Perioperative structure and process quality and safety indicators: a systematic review

Chazapis

Gilhooly

Smith

et al. 2018

British Journal of Anaesthesia

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Setting the bar: compliance with ovarian cancer quality indicators at a National Cancer Institute-designated Comprehensive Cancer Center

Cited by 11 publications

References 18 publications

Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center

Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center

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

Perioperative structure and process quality and safety indicators: a systematic review

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