Compliance to clinical guidelines for early-stage epithelial ovarian cancer in relation to patient outcome

Abstract

Objectives: To assess compliance to current surgical staging and adjuvant treatment guidelines for patients with early-stage epithelial ovarian carcinoma and its impact on overall survival. Methods: Patients diagnosed between 1991 and 1997 with early-stage ovarian cancer were recruited from the Regional Cancer Registry of the central region in the Netherlands. Demographic data, tumour characteristics, surgical findings and therapeutic data were abstracted from medical records. Patients were classified into optimal and non-optimal surgical staging. Overall survival was estimated using Kaplan-Meier method. To adjust for age hazard ratios for overall survival were estimated with a Cox Proportional Hazards model. Results: One hundred and twenty-five patients were included in the study, 41 of them (32.8%) were optimally staged. Guidelines for adjuvant radio-or chemotherapy were adequately followed in all 62 grade I patients and in 44 out of 59 grade II and III patients (74.6%). During 734.6 person-years of follow up 31 patients died. Five-year overall survival figures were 97.6% in the optimally staged group and 68.5% in the nonoptimally staged group. Patients who were non-optimally staged, had a significant higher risk to die than those who were optimally staged (HR: 7.4; 95% CI: 1.7-32.2). In patients with a grade II and III tumours, complete surgical staging still had a significant influence on survival (HR: 3.8; 95% CI 1.7-8.3).In women with grade II or III tumours, adjuvant radio-or chemotherapy administered in accordance to the guidelines did not improve overall survival regardless whether they were optimally staged or not. Conclusion: Incomplete staging in early-stage ovarian cancer leads to gross mis-classification in grade II and III tumours and to a lesser extent in grade I tumours. This leads to undertreatment in both surgical and adjuvant therapy. Subsequently unnecessary deaths may occur. More effort must be put in identifying obstacles interfering with compliance of guidelines #

Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer

“…Theoretically, this could lead to more advantageous effects of adjuvant chemotherapy in the ACTION and ICON1 trials, which cannot be demonstrated in our study, because of its retrospective nature. Sijmons et al [11] and Dinkelspiel et al [12] reported no significant benefits of adjuvant chemotherapy with respect to survival rates, which is in accordance with our data [11,12]. …”

“…However, both early- and advanced-stage ovarian cancer patients were included in this analysis. In 2006, Sijmons et al [11] published a retrospective cohort study analyzing adherence to guidelines in early-stage EOC patients in the Netherlands. In their study, it was shown that 10% of optimally staged patients and 7% of nonoptimally staged patients received chemotherapy.…”

Failure to Adhere to Protocol Specified Radiation Therapy Guidelines Was Associated With Decreased Survival in RTOG 9704—A Phase III Trial of Adjuvant Chemotherapy and Chemoradiotherapy for Patients With Resected Adenocarcinoma of the Pancreas

“…More recently, data have also become available from studies in oncologic contexts, both related and not related to the details of radiotherapeutic management, that confirm and reinforce the role of protocol adherence for optimal survival (23, 25–27). …”

Enhancing ovarian cancer care: a systematic review of guideline adherence and clinical variation

“…Of the 11 studies grouped under guideline adherence and deviation, 8 utilised the NCCN ovarian cancer guidelines as the comparator guideline, with 3 using their own local or national guidelines [3,[17][18][19][20][21][22][23][24][25][26]. These studies collectively indicated variation in adherence to guidelines for both surgical staging and receipt of chemotherapy.…”