RT Journal Article
SR Electronic
T1 Is Ovarian Cancer Being Managed According to Clinical Guidelines? Evidence From a Population-Based Clinical Audit
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP 1615
OP 1623
DO 10.1097/IGC.0000000000000830
VO 26
IS 9
A1 Simona Sobrero
A1 Eva Pagano
A1 Elisa Piovano
A1 Lorenzo Bono
A1 Manuela Ceccarelli
A1 Anna Ferrero
A1 Chiara Macchi
A1 Marinella Mistrangelo
A1 Silvia Patriarca
A1 Elisa Tripodi
A1 Roberto Zanetti
A1 Oscar Bertetto
A1 Giovannino Ciccone
A1 Paolo Zola
YR 2016
UL http://ijgc.bmj.com/content/26/9/1615.abstract
AB Background In the northwestern Italian region of Piedmont, current statistics on hospitalizations show that surgical treatment for ovarian cancer (OC) is taking place in many small hospitals, as opposed to a more centralized approach. A population-based clinical audit was promoted to investigate whether OC is being managed according to clinical guidelines, identify determinants of lack of adherence to guidelines, and evaluate the association between adherence to guidelines and survival.Patients and Methods Residents diagnosed with OC in 2009 were identified in the regional hospital discharge records database. All hospitalizations within 2 years from diagnosis were reviewed. Patients were classified according to their initial pattern of care, defined as “with curative intent” (CIPC) if including debulking surgery aimed at maximal cytoreduction. Adherence to guidelines for surgery and chemotherapy and the effects of this adherence on OC survival were investigated with logistic regression and Cox models.Results The final study sample consisted of 344 patients with OC, 215 (62.5%) of whom received CIPC. Increasing age, comorbidities, and metastases were negatively associated with receiving CIPC. In the CIPC group, surgical treatment was adherent to guidelines in 35.2%, whereas chemotherapy was adherent in 87.8%. Surgical treatment that was adherent to guidelines [hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.45–1.15] and absence of residual tumor (HR, 0.55; 95% CI, 0.32–0.94) were associated with better survival in the CIPC group, and chemotherapy that was adherent to guidelines was associated with a significant reduction in the risk of death (HR, 0.49; 95% CI, 0.28–0.87).Conclusions Results support the need to reorganize the clinical pathway of patients with OC in the Piedmont Region and the need for better adherence to current guidelines.