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Exploring global barriers to optimal ovarian cancer care: thematic analysis
  1. Selina Sfeir1,
  2. Lucy Allen1,
  3. Marc Daniël Algera2,3,4,
  4. Rhett Morton5,
  5. Rhonda Farrell6,7,
  6. Donal Brennan8,
  7. Willemien J van Driel9,
  8. Marcus J Rijken9,
  9. Mary Eiken10,
  10. Sudha S Sundar11 and
  11. Robert L Coleman12
  12. the collaborators of the Global Equality in Ovarian Cancer Care project group
      1. 1University of Birmingham, Birmingham, UK
      2. 2Gynaecological Oncology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
      3. 3Maastricht University GROW Research Institute for Oncology and Reproduction, Maastricht, Limburg, The Netherlands
      4. 4Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
      5. 5University of Queensland Queensland Centre for Gynaecological Cancer Research, Herston, Queensland, Australia
      6. 6Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
      7. 7Medicine, University of Sydney, Sydney, New South Wales, Australia
      8. 8Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
      9. 9Center for Gynaecological Oncology Amsterdam, Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
      10. 10International Gynecologic Cancer Society, Austin, Texas, USA
      11. 11Department of Gynaecology Oncology, University of Birmingham, Birmingham, UK
      12. 12Gynecologic Oncology, Texas Oncology Houston Memorial City, Shenandoah, Texas, USA
      1. Correspondence to Dr Marc Daniël Algera, Gynaecology, Maastricht University Medical Centre+, Maastricht, 6229 HX, The Netherlands; m.algera{at}


      Objective To explore the barriers to ovarian cancer care, as reported in the open ended responses of a global expert opinion survey, highlighting areas for improvement in global ovarian cancer care. Potential solutions to overcome these barriers are proposed.

      Methods Data from the expert opinion survey, designed to assess the organization of ovarian cancer care worldwide, were analyzed. The survey was distributed across a global network of physicians. We examined free text, open ended responses concerning the barriers to ovarian cancer care. A qualitative thematic analysis was conducted to identify, analyze, and report meaningful patterns within the data.

      Results A total of 1059 physicians from 115 countries completed the survey, with 438 physicians from 93 countries commenting on the barriers to ovarian cancer care. Thematic analysis gave five major themes, regardless of income category or location: societal factors, inadequate resources in hospital, economic barriers, organization of the specialty, and need for early detection. Suggested solutions include accessible resource stratified guidelines, multidisciplinary teamwork, public education, and development of gynecological oncology training pathways internationally.

      Conclusions This analysis provides an international perspective on the main barriers to optimal ovarian cancer care. The themes derived from our analysis highlight key target areas to focus efforts to reduce inequalities in global care. Future regional analysis involving local representatives will enable country specific recommendations to improve the quality of care and ultimately to work towards closing the care gap.

      • Ovarian Cancer

      Data availability statement

      Data are available upon reasonable request.

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      • X @donalb5, @sundar_sudha, @rcoledude

      • SS, LA and MDA contributed equally.

      • Collaborators The following collaborators of the Global Equality in Ovarian Cancer Care project group co-developed the survey and read and approved the manuscript: B Moran (Wellington Hospital, London, UK), A Alvarez Secord (Duke Cancer Institute, Durham, UK), G Baiocchi (AC Camargo Cancer Center, Sao Paulo, Brazil), K Fujiwara (Saitama Medical University, Saitama, Japan), A Mukhopadhyay (Chittaranjan National Cancer Institute, Kolkata, India), N Concin (Innsbruck Medical University, Innsbruck, Austria), A Fagotti (A Gemelli University Hospital Foundation, Rome, Italy), M Leitao (Memorial Sloan Kettering Cancer Center, New York, USA), O Zivanovic (Memorial Sloan Kettering Cancer Center, New York, USA), D Leopold (International Gynecologic Cancer Society), A Shevchuk (NN Blokhin National Medical Research Center of Oncology, Moscow, Russia), D Atallah (Saint Joseph University, Beirut, Lebanon), A Bhatti (India), WA Cliby (Mayo Clinic Comprehensive Cancer Center, Rochester, USA), SJ Chang (South Korea), I De Hingh (Catharina Hospital, Eindhoven, the Netherlands), G Dreyer (University of Pretoria, Pretoria, South Africa), A Dubois (Gutenberg University, Essen, Germany), O Glehen (Hospices Civils de Lyon, Lyon, France), AHS Kim (South Korea), JW Kim (Seoul National University College of Medicine, South Korea), P Morice (Institut Gustave Roussy, Villejuif, France), B Naoual (Hospices Civils de Lyon, Lyon, France), J Soon Yau Ng (National University Cancer Institute, Singapore, Singapore), A Nogueira Rodrigues (Brazilian Group of Gynecologic Oncology, Brazil), L Randall (VCU Medical Center, Richmond, USA), B Rau (University Hospital Berlin, Berlin, Germany), M Seoud (Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates), I Vergote (University Hospital Leuven, Leuven, Belgium).

      • Contributors SS, LA, and MDA are shared first authors who contributed equally to the manuscript. SS and LA performed the qualitative analysis. SS, LA, and MDA wrote the manuscript. MDA is the guarantor and performed the descriptive analysis. RM revised the manuscript and performed the analysis. RF, DB, WJvD, MJR, ME, SSS, and RLC performed the interpretation of the data and revision of the manuscript. The collaborators all read and approved the manuscript.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

      • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

      • Competing interests The authors declare no conflict of interest or disclosures in relation to this work. RLC received grants or contracts in the past 36 months from AstraZeneca, Clovix, Genelux, Genmab, Merck, Immunogen, and Roche/Genentech. RLC received consulting fees from Agenus, Alkermes, AstraZeneca, Clovis, Deciphera, Genelux, Genmab, GSK, Immunogen, OncoQuest, Onxerna, Regeneron, Roche/Genentech, Novocure, Merck, and Abbvie (unrelated to this work). RLC received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from AstraZeneca, Clovis, Roche/Genentech, and Merck (unrelated to this work). RLC was participating in a Data Safety Monitoring Board or Advisory Board at VBL Therapeutics and Eisai/BMS (unrelated to this work). SSS received honoraria from AstraZeneca, MSD, and GSK for conference presentations unrelated to this work. RF received honoraria from IGCS for council meetings, unrelated to this work.

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

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