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Abstract
Introduction Epithelial ovarian cancer (EOC) is the most deadly gynecological cancer. In 2016 the Piedmont and Valle d’Aosta Oncology Network launched an Audit and Feedback (A&F) intervention to improve the quality of care for patients with ovarian cancer (EASY-NET Project – grant numberNET-2016–02364191).
Methods Patients treated in all the regional hospitals, from May 2016 to September 2020 for newly diagnosed EOC were monitored over time for ESGO process and outcome indicators. Data were collected by all centres through a web-based database (https://www.epiclin.it/audit_ovaio) and centrally monitored. The main purpose of the A&F was increasing the adherence to the guideline recommendations, reducing overdispersion of cases and monitoring survival. In the reports the adherence to ESGO indicators was classified as: high (≥75% – green), medium (75–60% – blue) and low (≤60% – red) (table 1). Overall survival (OS) was analysed with a multivariable Cox model including year of diagnosis and relevant prognostic factors.
Adherence to ESGO indicators by year
Kaplan-Meier survival curve by year of enrollment
Results The present analysis includes 1089 patients with EOC (23.3% early, 76.7% advanced). The analysis of the indicators shows an improvement over the years, both in diagnosis and in treatment phases (table 1). Some area needing improvement are still present in chemotherapy supply. The total number of treating hospitals shows a reduction over time (from 30 in 2016 to 17 in 2020). A multivariate Cox model shows that adherence to surgical guidelines represents a strong favourable effect on OS (HR=0.54; CI95% 0.39–0.74) after adjusting for other relevant prognostic factors (age and stage). No time effect is evidenced on OS (figure 1), at this point (mean follow-up time of 2 years).
Conclusions The A&F intervention was effective in the identification of critical issues, in improving adherence to guidelines and in reducing overdispersion and variability among regional hospitals. Survival improvement over time has to be confirmed with a longer follow-up.