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Quality management program in epithelial ovarian cancer: proposal in a Latin American country
  1. Daniel Sanabria1,
  2. Maria Camila Fernández1,
  3. Natalia Hurtado2,
  4. Adriana Ramos1 and
  5. Juliana Rodriguez1
  1. 1Department of Gynecology, Obstetrics and Human Reproduction, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia
  2. 2Department of Gynecology and Obstetrics, Universidad El Bosque, Bogota, Colombia
  1. Correspondence to Dr Juliana Rodriguez, Department of Gynecology, Obstetrics and Human Reproduction, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogota, Colombia; julianalrc1106{at}gmail.com

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Ovarian cancer is the most lethal gynecological neoplasm and the ninth most common in women. Worldwide, by 2020, 313 959 cases had been diagnosed, and 207 252 women had died from this disease. For Latin America and the Caribbean, age-adjusted incidence and mortality rates of 14.9 and 7.6 per 100 000 women per year were reported, respectively.1 Approximately 75% of patients will have advanced disease at diagnosis. When possible, the standard treatment is primary cytoreductive surgery followed by platinum-based cytotoxic chemotherapy. The use of maintenance therapies has also been suggested in different clinical settings.2 Complete tumor resection has proven to be the most important prognostic factor for survival in these patients.3

Quality of surgical care is a major component of the multidisciplinary management of the disease.4 Implementation of a quality program allows for reduction in morbidity and costs.5 Different organizations promote improvement in the care of ovarian neoplasms. For instance, the European Society for Gynaecological Oncology (ESGO) certification for advanced ovarian cancer surgery is an award attributed to institutions which can offer patients the specific skills, experience, organization, and dedication that are required to achieve optimal levels of surgical care. The ESGO certification is based on the completion of 10 quality indicators and a scoring system.6 Currently, there are more than 60 accredited centers in Europe and Asia.7

In Latin America, non-medical barriers to cytoreductive surgery have been identified: low surgeon expertise, limitations on access, and/or inadequate resources.8 In Colombia, care is predominantly decentralized. There are no centers of excellence in ovarian cancer. In 2018, the project “Center for clinical care in epithelial ovarian cancer” was created at the Fundacion Santa Fe de Bogota, a private institution. The objectives of the center are to form an interdisciplinary working group specialized in the comprehensive management of epithelial ovarian cancer, to create protocols for diagnosis, treatment and follow-up, to meet international quality indicators, and to reduce costs associated with treatment. The inclusion criteria are: patients older than 18 years and younger than 75 years, histopathological confirmation of epithelial cancer of the ovary and/or fallopian tube, and stages I/IVA susceptible to management of cytoreductive surgery and intravenous chemotherapy.

The center has four phases of the process: diagnosis, surgical management, clinical oncologic process, and follow-up (Figure 1). A standardized protocol has been designed for each of these phases. There is the participation of a multidisciplinary team made up of 20 specialties, state-of-the-art technology, and infrastructure. The center has quality indicators adapted and aligned with international standards9 (Table 1). Active work has also been done on educating women and strengthening their support networks, through patient-focused symposiums (Figure 2). Currently this program is in the self-evaluation phase and is waiting to complete the accreditation by the Joint Commission International.

Figure 1

Flowchart of the process of the clinical care center

Figure 2

Patient symposium, May 2022.

Table 1

Quality indicators in the ovarian cancer program

Ovarian cancer care is challenging, especially in developing countries. The introduction of quality programs and management centralization of this condition will improve not only care, but clinically relevant outcomes in our population.

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References

Footnotes

  • Twitter @danielsanabrias

  • Contributors Study design: DS, JR. Data acquisition: JR, MCF, AR, NH. Manuscript writing: DS, JR. Manuscript review: DS, JR, MCF, AR, NH.

  • Funding This study was funded by AstraZeneca sponsorship Nintex 372.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.