3.3. Key question 2 \ In women with a diagnosis of endometrial' cancer, should pelvic or para-aortic lymphadenectomy be carried out.

Transcription

1 >. Topic proposal. I understand that this proposal will be retained by the Programme Lead and be made available on the website for time period that the proposal is being considered. Only proposals with a completed Declaration of Interests for the principal proposer will bla considered 1. What is the problem/need for a guideline/clinical scenario? Diagnosis and Management of Endometrial Cancer 2. Burden of the condition Mortality (from CRUK ) Number of Deaths, Crude and European Age-Standardised(AS) Mortality Rates per 1()O,OOO Population, Females, UK Deaths Crude Rate AS Rate AS Rate - 95% LCL AS Rate - 95% UCL E flg l a n~ _. Wa les _. 1,678 ' Scotland N0I1hern Ire land UK 2, Incidence Commonest female gynaecological cancer Prevalence Rising due to rise in obesity, increase in elderly population 3. Variations In practice in Scotland '. There exists wide variation in diagnostic pathways, imaging (CT vs MRI, role of PET) surgical management (Iaparoscopic versus open, whether lymphadenectomy is performed) and post operative adjuvant therapy. In health outcomes in Scotland 4. Areas of uncertainty to be covered Key question 1 In women with post-menopausal bleeding what are the best tests to diagnose or exclude endometrial cancer? Key question 2 \ In women with a diagnosis of endometrial' cancer, should pelvic or para-aortic lymphadenectomy be carried out. Key question 3 In women who have had surgical management of endometrial cancer which patients require,adjuvant radio or chemotherapy? 5. Areas that will not be covered Uterine sarcomas 6. Aspects of the proposed clinical topic that are key areas of' concern for patients, carers and/or the organisations that represent them Across Scotland the waiting times for diagnosis of endometrial cancer are longer than

2 recommended. There is a need to reduce patient anxiety by improving patient pathways to diagnosis and reassuring women Who do not have cancer. Methods of investigation of PMB vary across Scotland. The withdrawal of a previous guideline covering management of PMB means there is little guidance for ensuring. equality and consistency across the country. Publication of guidance will likely lead to greater patient awareness and increase early detection of endometrial cancer. 7. Population Included All women presenting to their GP with PMB. All women with a diagnosis of endometrial cancer. _- Not included Males!

3 'w 8. Healthcare setting Included Primary, secondary & tertiary care Not included 9. Potential Potential to improve current practice A guideline will improve care in surgery (encouraging laparoscopic surgery over open), will set standards for diagnostic testing, and encourage uniformity of practice across the country. Potential impact on important health outcomes (name measureable indicators) Reduce time to diagnosis. Unknown impact on survival. Potential impact on resources (name measureable indicators) Unlikely to change resources, but may streamline use of curre~nt services. 10. What evidence based guidance is currently available? Out-of-date (list) Publication No. 61 Investigation of Post-Menopausall Bleeding Current (list) 1. Querleu et al (2011). Clinical Practice Guidelines for the Management of Patients with Endometrial cancer in France. Recommendations of the Institut National du Cancer and the Societe Francaise d'oncologie Gynecologique. International Journal of Gynecological Cancer..?, American College of Obstetricians and Gynecologists (2005). ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician-Gynecologists, Number 65, August 2005: Management of Endometrial Cancer. Obstetrics & Gynecology. 106(2L Relevance to current Scottish Government policies Detecting Cancer Early 12. Who is this guidance for? GPs, Pratice Nurses, Gynaecologists, Gynaecological Oncologists, Clinical oncologists, Sexual health care physicians and nurses, Radiologists, Ultrasonographers j Trainee doctors i the above specialties m plementation Links with existing audit programmes Links with OPI in Endometrial Cancer Existing educational initiatives known Strategies for monitoring implementation Regional impact assessment 14. Primary contact for topic proposal Dr Scott Fegan

4 15. Group(s) or institution(s) supporting th~ proposal SCAN Network Gynae Group

5 . Declaration of Interests Please complete all sections and if you have nothing to declare please put 'NIA Having read the Policy on Declaration of Competing Interests I declare the following competing interests for the previous year, and the following year. I understand that this declaration will be retained by the Programme Lead and be made available on the website for time period that the proposal is being considered.. r:;y-- Signature: Name: Relationship to : t\ k'~ Dr Scon FegiaDJ Topic proposal primary contact Date: If> I oq I f ~ Date received at : Personal Interests R emunera f Ion f rom emp oymen t Name of Employer Nature of Business Self or partnerl Specific? and Post held relative Details of employment hel,d NHS Lothian, Consultant Gynaecological Oncologist Hospital Doctor Remuneration from self employment Name of Business Nature of Business Self or partner'- Specific? relative Details of self employment held Remuneration as holder of paid office Nature of Office Organisation Self or partnerl Specific? held re~lative, Details of office held..

6 Remuneration as a director of an undertaking Name of Nature of Business Self elr partnerl Specific? Undertaking rellative Details of directorship held, Remuneration as a partner in a firm Name of Nature of Business Self or partnerl Specific? Partnership relative Details of Partnership held ' : Shares and securities Description of Description of Self or partner! Specific? organisation nature of holding - relative (value need not be disclosed) Details of interests in shares and securities in commercial healthcare - companies, organisations and undertakings Remuneration from consultancy or other fee paid work commissioned by, or gifts from, commercial healthcare companies, organisations and undertakings Nature of work Forwhom Self or partner! Specific? undertaken and relative frequency Details of consultancy or ) other fee paid work significant of to, or '

7 ... Details of gifts Non-financial interests Description of interest Self or partner! relative Specific'? Details of nonfinancial interests Non-personal interests Name of company, organisation or undertaking Nature of interest Details of nonpersonal support from commercial healthcare companies, organisations or undertakings Signature~. ~~. ~1Jf'd\-f---_' _ Date: Thank you for completing this form, Please return to Roberta James Programme Lead Executive, Healthcare Improvement Scotland, Gyle Square 11 South Gyle Crescent 1 Edinburgh 1 EH12 9EB t: e:roberta.james@nhs.net Data Protection Your details will be stored on a database for the purposes of managing this guideline topic proposal. We may retain your details so. that we can contact you about future Healthcare Improvement Scotland activities. We will not pass these details on to any third parties. Please indicate if you do not want your details to be stored after the proposal is published.

8 Initial screen Purpose: initial screening by Senior Management Team to exclude proposals that are neither clinical, nor multi-professional, nor appropriate for the process. 1. Is this an appropriate clinical topic for a guideline? Is it a clinical topic, what is the breadth of the topic and is there a need for the guideline as identified in the proposal? Yes, although there are concerns that questions 2 and 3 are specialist while 1 is generalist and how the three questions would sit together in a single guideline. Perhaps it would be more obvious if the questions included outcomes. 2. Is there a suitable alternative product which would address this topic? Would another Healthcare Improvement Scotland product better address the topic? No, this guideline would partially replace the withdrawn guideline on post-menopausal bleeding. 3. Has this topic been considered before and rejected? What were the reasons for rejection and are they still applicable No 4. Outcome Go forward to the next stage of topic selection YES Reject