Survival in ovarian cancer in Wales: prior to introduction of all Wales guidelines

Abstract

The objective of the study was to review referral practice, overall management, and survival in women with suspected ovarian cancer in Wales. This study was done prior to introduction of cancer management guidelines in the region. A confidential study questionnaire was sent to 20 participating hospitals. Data on 287 consecutive women with suspected ovarian cancer were collected, of which 250 women underwent primary laparotomy. Information was obtained on referral pattern, preoperative investigations, place of primary surgery, specialty of the primary surgeon, surgical parameters recorded at the time of operation, a final overall stage, adjuvant treatment, and survival outcome. There was a wide variation in referral practice and management of ovarian cancer in Wales. Stage of the disease, attempt at optimal debulking, residual disease, management by a cancer centre multidisciplinary team, and platinum-based chemotherapy were associated with improved overall survival and progression-free survival. More women were alive if managed in the cancer centre at 1 and 3 year after diagnosis (P = 0.022). This study has highlighted the acute issue of the standards of clinical care in the area of ovarian cancer management and will emphasize the implementation of better care pathways for ovarian cancers.

Prognostic Factors Affecting Survival in Patients with Ovarian Cancer: A 5-Year Experience in an University Hospital.

“…6,9,11,18,20 Similar to others, we found that women with clear cell, endrometrioid and mucinous type had the poorest survival, possibly reflecting aggressive tumor biology or less sensitivity to routinely used chemotherapy. However, Benvito et 23 and Shysasree et al 28 were not found of survival differences between subtypes and survival. Akhtar-Danesh et al 22 reported that the worst survival observed for serous tumors.…”

“…Consistent with other work, we also revealed that high stage had significantly effect on OS (p< 0.05). In contrast, Shylasree et al 28 analyzed the outcomes of 250 women with OC and there were no significant differences regarding stage between OS.…”

“…Access to on site appropriately qualified healthcare center is essential to decrease distance barriers and to improve survival. 22 Conversely, Shylasree et al 28 analyzed that there were no significant differences survival between women managed in the cancer center and those managed in the peripheral units. In our study, the patients are referred to the study hospital because they do not have a high-quality healthcare setting in the periphery.…”

“…The majority of studies show that comorbidities were found as the prognostic factors that influence the survival. 6,18,28,29 In a different study 20 , a high comorbidity score of ≥2 was associated with a decreased OS rates (HR, 1.5 [95% CI, 1.1-2.1]). When we performed our analyses, we either did found a relationship, higher comorbidity score was found to have poorer OS.…”

Patterns of care in surgery for ovarian cancer in Europe

“…Population based data on the number of advanced ovarian cancer patients operated by a gynaecological oncologist are available in the literature for Sweden [22], Finland [23], Switzerland [24], United Kingdom [25][26][27], Denmark [28], the Netherlands [29] and Norway [30]. Data are summarised in Table 1.…”