Factors Affecting Short-term Mortality in Women With Ovarian, Tubal, or Primary Peritoneal Cancer: Population-Based Cohort Analysis of English National Cancer Registration Data

Abstract

Although our results are based on data from England, they are likely to have implications for cancer care pathways worldwide because most of the identified factors are not specific to the UK health care system. Our results suggest the need to increase symptom awareness, promote timely general practitioner referral, and optimize diagnostic and early treatment pathways within secondary care to increase access to treatment for women with advanced-stage invasive epithelial ovarian, tubal, and primary peritoneal cancer. This process should be pursued alongside continued efforts to develop primary prevention and screening strategies.

Ovarian cancer symptoms, routes to diagnosis and survival – Population cohort study in the ‘no screen’ arm of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

“…Our findings that emergency presentation confers worse survival compared with two-week urgent ‘cancer’ referral are in line with Barclay et al [ 25 ] and Altman et al [ 26 ]. It highlights the need to ensure for fast tracking of referrals to gynaecological services.…”

Which indicators of early cancer diagnosis from population-based data sources are associated with short-term mortality and survival?

“…We found that emergency presentation was associated with higher 30-day mortality and lower medium-term survival for patients at every age and stage disease, consistent with other studies [44,45]. This indicator is therefore a proxy for other factors which independently determine survival, and is a valuable complimentary prognostic indicator to stage.…”

“…In one survey of expert judgement for 21 common cancers [43,44] there was consensus that expedited diagnosis brings mortality reductions for 11 cancers. They were undecided for seven cancers, and disagreed that expedited diagnosis conferred any mortality benefit for three.…”

Diaphragm disease in advanced ovarian cancer: Predictability of pre-operative imaging and safety of surgical intervention

“…A more selective approach to surgical candidates will increase the diaphragmatic resection rate as only the fittest with localised disease receive surgery. The Pan-Birmingham Gynaecological Cancer Centre has a high operated patient rate of 71.8% compared to the 56% that appears standard in the UK [25].…”