Introduction/Background*Epithelial ovarian cancer (EOC) is the most lethal gynaecological cancer with 3285 estimated deaths in Italy in 2021. In 2016, the Piedmont and Valle d’Aosta Oncology Network (NW Italy) started on an Audit and Feedback (A&F) intervention to improve the quality and equity of care for ovarian cancer patients residing in Piedmont. This A&F is part of the activities of the EASY-NET network program (https://easy-net.info/).
Methodology All consecutive patients treated for newly diagnosed EOC were included by 34 centres from May 2016 to September 2020. Clinical data were entered in a dedicated web database and data quality was centrally monitored. During the audit, 14 feedback meetings were organized with the participating centres to discuss data quality and preliminary results. The treating hospitals were classified according to the mean yearly volume of surgical activity (≥35; 34-18; <18 patients). Adherence to previously selected structure, process and outcome indicators were analysed by volume of activity of the centre and semester of enrolment. Adherence was classified as: high (>75%), medium (75-60%) and low (<60%). Overall survival (OS) was analysed with a multivariable Cox model including prognostic factors, hospital volume of activity and level of adherence to process indicators.
Result(s)*The present analysis includes 905 patients with EOC diagnosed until December 2019 (23.4% early stages, 76.6% advanced). Out of 12 analysed indicators, 4 showed a high level of adherence (e.g., Completeness of diagnosis and staging: 83%), 3 a medium level (e.g., Adherence to surgical guidelines: 65.5%) and 5 a low level (e.g., Timing and number of cycles for NACT: 57.1%). In general, there was a lower adherence to guidelines by centres with a low volume of activity. For most of the indicators there was an improvement over time. Adherence to guidelines was associated to better OS after adjustment for prognostic factors.
Conclusion*The A&F intervention was useful to support the identification of reference centres, to promote centralization, to reduce variability among regional hospitals and to increase the appropriateness of treatment. Adherence to guideline recommendations was associated to a better outcome.
The EASY-NET project was funded by Ministry of Health and participating Regions (NET-2016-02364191).
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