Ovarian Cancer Quality Performance Indicators (QPI) Comparative Report

Transcription

1 SOUTH EAST SCOTLAND CANCER NETWORK (SCAN) PROSPECTIVE CANCER AUDIT Ovarian Cancer Quality Performance Indicators (QPI) Comparative Report Dr Cameron Martin, SCAN Lead Ovarian Cancer Clinician Dr Scott Fegan, NHS Fife & NHS Lothian Dr Phillip Dutton, NHS Dumfries and Galloway Dr Queenie Menezes, NHS Borders Dr Melanie Mackean, NHS Lothian Dr Lorna Bruce, NHS Lothian, SCAN Cancer Audit Manager Martin Keith, Cancer Audit Facilitator, NHS Dumfries and Galloway Alistair Meikle, Cancer Audit Facilitator, NHS Borders Jackie Stevenson, Cancer Audit Facilitator, NHS Fife Report number: SA Ov02/16 SCAN Audit Office, c/o Department of Clinical Oncology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU T: W:

2 Contents Document History... 3 Clinical recommendations... 4 Attainment of QPIs... 5 Introduction and Methods... 7 Audit Processes... 8 Estimate of Case Ascertainment... 8 Age at Diagnosis... 9 QPI 1 Risk of Malignancy Index QPI2 Extent of disease assessed by CT or MRI prior to treatment QPI 3 - Treatment planned and reviewed at a multi-disciplinary team meeting QPI 4 - Patients with early stage disease have an adequate staging operation QPI 5 - No macroscopic residual disease QPI 6 - Histopathology reports are complete QPI 7 - Histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy.. 18 QPI 8 - Delayed primary surgery QPI 9 - First-line Chemotherapy Ovarian Cancer Glossary of Terms SCAN Comparative Ovarian Cancer QPI Report SA Ov02/16 2

3 Document History v Date Events Actions 1 17/02/16 Sent to SCAN Chair Commentary required 2 18/02/16 Sent To SCAN Group Minor typos corrected 3 23/03/16 Chairs commentary added. Circulated to SCAN Group and clinical governance framework Action Plans to be completed by 19/4/16 4 Nov 2016 Published to Website Disclosure checks completed Comment by the Chair of the SCAN Gynaecology Group Our prospective cancer audit Ovarian Cancer Quality Performance Indicators (QPI) Comparative Report has been expertly compiled by Lorna Bruce, SCAN Audit Manager (Lothian) with input from our Regional Audit Facilitators, Martin Keith (Dumfries and Galloway) Alastair Meikle (Borders) and Jackie Stevenson (Fife). Our dataset continues to provide consistently high quality information to benchmark against other networks and allows us to strive to continuously improve delivery of care to patients in our region. We established the first complex multidisciplinary combined colorectal/gynaecological/urological meeting in Scotland two years ago. This surgical service became firmly established in the past year with fixed operative sessions and planning MDM. It allow us to optimally plan radical combined surgery in patients with ovarian cancer. In particular, the combined operative approach has meant a huge step forward in providing primary cytoreductive surgery with an aim to radically fully resect to zero residual disease at primary surgery which is associated with long term survival. We look forward to two year data analysis of disease free survival in our patients. At our recent education day we were able to compare our data relating to numbers of patients having radical primary surgery and zero residual status to data produced (and shared) by NoSCAN and WoSCAN. I am delighted to report that SCAN is considerably advanced in this aspect of service delivery and we are confident that this will be realised in the future with improved survival in patients with advanced ovarian cancer. Despite our success, we do not remain complacent and have been working hard to ensure that unmet QPI targets are addressed. In particular, two notable areas are the recording of risk of malignancy index (RMI) in the planning stages and recording of residual disease at surgery have been carefully assessed. We now have an additional area on referral forms (now all electronic) to record RMI and have been trialling a standardised operative proforma which will be loaded onto TRAK to ensure residual disease (a prognostic marker) is recorded. One further area is the proportion of patients who are discussed and operated on by a subspecialist gynaecological oncologist. Many of our patients who have caused us SCAN Comparative Ovarian Cancer QPI Report SA Ov02/16 3

4 to fall below QPI targets are admitted as emergencies and may require immediate surgery. We are considering ways which allow this small group of patients to still receive best quality care. Reassuringly, we achieve excellent results in other QPI which confirm our continuing quality of care. I am happy with our overall performance and I am confident that we are working towards and will achieve necessary QPI targets. Cameron Martin Chair, SCAN Gynaecology Group March 2016 Clinical recommendations QPI Action required Person responsible for action Date for update 1 Include box to record RMI on MDM referral form Dr Martin Cameron Dr Scott Fegan, Dr Phillip Dutton, Dr Queenie Menezes 25/2/16 3 Lothian surgical patients to be reviewed Dr Martin Cameron Dr Scott Fegan 25/2/16 5ii Lothian action - Review patients with residual disease 5cm or more Dr Martin Cameron Dr Scott Fegan 25/2/16 6 SCAN Pathologists to use proforma for pathology reporting Dr Alistair Williams, Dr Awatif Al-Nafussi 25/02/16 SCAN Comparative Ovarian Cancer QPI Report SA Ov02/16 4

5 Attainment of QPIs QPI Target Borders D&G Fife Lothian SCAN 1 2 Risk of Malignancy Index recorded in the patient notes - Proportion of patients with Stage 1 epithelial ovarian cancer having RMI assessed and recorded in their notes prior to any definitive surgical intervention. Extent of disease assessed by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) prior to treatment - Proportion of patients with epithelial ovarian cancer having a CT scan or MRI of the abdomen and pelvis performed to exclude the presence of metastatic disease prior to starting definitive treatment. 90% 33.3% 25.0% 25.0% 8.3% 17.4% 90% 100.0% 100.0% 96.2% 98.5% 98.3% 3 Treatment planned and reviewed at a multi-disciplinary team meeting - Proportion of patients with epithelial ovarian cancer who are discussed at a MDT meeting before definitive treatment. 95% 81.8% 87.5% 77.8% 81.7% 81.6% 4 Patients with early stage (FIGO Stage 1) disease have an adequate staging operation 4i All early stage epithelial ovarian cancer patients having primary surgery 95% 100.0% 100.0% 100.0% 76.9% 86.4% 4ii Early stage epithelial ovarian cancer patients operated on by a gynaecological oncologist 95% 100.0% 100.0% 100.0% 100.0% 100.0% 5 No macroscopic residual disease following surgery for advanced disease 5i Proportion of patients with no macroscopic residual disease following surgery. 30% 75.0% 66.7% 53.3% 41.0% 47.5% 5ii Proportion of patients with macroscopic residual disease < 1cm following surgery. 60% 100.0% 66.7% 86.7% 59.0% 68.9% 6 Histopathology reports are complete and support clinical decision-making - Proportion of patients with epithelial ovarian cancer undergoing pelvic clearance surgery having a complete pathology report as defined by the Royal College of Pathologists. 90% 83.3% 100.0% 81.0% 91.7% 89.2% SCAN Comparative Ovarian Cancer Report SA Ov02/16 5

6 QPI Target Borders D&G Fife Lothian SCAN 7 Histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy Proportion of patients with epithelial ovarian cancer having a histo/cytological diagnosis prior to 7i starting neo-adjuvant chemotherapy. Proportion of patients with epithelial ovarian cancer having histo/cytological diagnosis recorded prior 7ii to starting neo-adjuvant chemotherapy who have histological confirmation obtained by percutaneous image-guided biopsy or laparoscopy. 8 Delayed primary surgery 8i Proportion of patients with advanced epithelial ovarian cancer having delayed primary surgery following neo-adjuvant chemotherapy. 100% N/A 100.0% 100.0% 100.0% 100.0% 80% N/A 100.0% 100.0% 76.9% 83.3% 75% N/A 50.0% 83.3% 77.3% 75.0% 8ii Proportion of patients undergoing delayed primary surgery with residual disease <1cm. 65% N/A 100.0% 100.0% 82.4% 87.50% 9 First-line Chemotherapy - Proportion of epithelial ovarian cancer patients who receive platinumbased chemotherapy, either in combination or as a single agent. 90% 77.8% 80.0% 95.8% 85.7% 86.5% QPI Not met QPI Met SCAN Comparative Ovarian Cancer Report SA Ov02/16 6

7 Introduction and Methods Cohort This report covers patients diagnosed with an Ovarian cancer from 01/10/ /09/14. The results contained within this report have been presented by NHS board of diagnosis, where the QPI relates to surgical outcomes the results have also been presented by Board of surgery. Dataset and Definitions The QPIs have been developed collaboratively with the three Regional Cancer Networks, Information Services Division (ISD), and Healthcare Improvement Scotland. QPIs will be kept under regular review and be responsive to changes in clinical practice and emerging evidence. The overarching aim of the cancer quality work programme is to ensure that activity at NHS board level is focussed on areas most important in terms of improving survival and patient experience whilst reducing variance and ensuring safe, effective and person-centred cancer care. Following a period of development, public engagement and finalisation, each set of QPIs is published by Healthcare Improvement Scotland 1. Accompanying datasets and measurability criteria for QPIs are published on the ISD website 2. NHS boards are required to report against QPIs as part of a mandatory, publicly reported, programme at a national level. The QPI dataset for Ovarian Cancer was implemented from 01/10/2013, and this is the first publication of QPI results for Ovarian cancer within SCAN. The standard QPI format is shown below: Results are shown by Board of diagnosis as standard and additionally by Board of surgery where required. QPI Title: Description: Rationale and Evidence: Specifications: Target: Short title of Quality Performance Indicator (for use in reports etc.) Full and clear description of the Quality Performance Indicator. Description of the evidence base and rationale which underpins this indicator. Of all the patients included in the denominator those Numerator: who meet the criteria set out in the indicator. All patients to be included in the measurement of this Denominator: indicator. Patients who should be excluded from measurement Exclusions: of this indicator. Include in the denominator for measurement against Not recorded for the target. Present as not recorded only if the patient numerator: cannot otherwise be identified as having met/not met the target. Not recorded for exclusion: Not recorded for denominator: Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard. Statement of the level of performance to be achieved. 1 QPI documents are available at 2 Datasets and measurability documents are available at SCAN Comparative Ovarian Cancer Report SA Ov02/16-7 -

8 Audit Processes Data was analysed by the audit facilitators in each NHS board according to the measurability document provided by ISD. SCAN data was collated by Chris Burns SCAN Cancer Audit Facilitator. Patients were mainly identified through registration at weekly multidisciplinary meetings, and through checks made against pathology listings and GRO death listings. Data capture was dependent on casenote audit and review of various hospitals electronic records systems. Data was recorded in ecase for Borders, Dumfries & Galloway and Fife, Lothian data was recorded on MS Access. Lead Clinicians and Audit Personnel SCAN Region Hospital Lead Clinician Audit Support Borders General Dr Queenie NHS Borders Alistair Meikle Hospital Menezes NHS Dumfries Dumfries & Galloway Dr Philip Dutton Laura Halliday & Galloway Royal Infirmary Queen Margaret Jackie NHS Fife Hospital Dr Scott Fegan Stevenson Victoria Hospital SCAN & NHS Lothian St Johns Hospital Royal Infirmary Edinburgh Western General Hospital Dr Cameron Martin Chris Burns and Lorna Bruce Data Quality Quality Assurance All hospitals in mainland Scotland participate in a Quality Assurance (QA) programme provided by the National Services Scotland Information Services Division (ISD). QA of the Ovarian QPI dataset is yet to be undertaken. Clinical Sign-off To ensure the quality of the data and the results presented, the process was as follows: Individual health board results were reviewed and signed-off locally. Collated results were presented and discussed at the SCAN Clinical Leads sign off meeting 27 th August The final regional results were presented and discussed at the SCAN Gynae Meeting on 3 rd September National data was collated for the SCAN Gynae Education Day on 27 th November where the QPI results were discussed in depth. Estimate of Case Ascertainment A rough estimate of case ascertainment is made by comparison with the Scottish Cancer Registry five-year average data from 2008 to However, results must be interpreted with caution as Cancer Registry data includes all ovarian cancers whereas the QPI dataset includes only epithelial ovarian cancers. High levels of case ascertainment should provide confidence in the completeness of the audit recording and contribute to the reliability of results presented. Levels greater than 100% may be attributable to an increase in incidence. Allowance should be made when reviewing results where numbers are small and variation may be due to chance. SCAN Comparative Ovarian Cancer Report SA Ov02/16-8 -

9 Number of cases recorded in audit: patients diagnosed 1/10/13-30/9/14 Borders D&G Fife Lothian SCAN Total Estimate of case ascertainment: calculated using the average of the most recent available five years of Cancer Registry Data Borders D&G Fife Lothian SCAN Cases from Audit Cancer Registry 5 Year Average Case Ascertainment % Source: Scottish Cancer Registry, ISD. Data extracted from ACaDMe, November 2015 Note: Case ascertainment is reported by board of diagnosis and has been estimated using a denominator based on the latest ( ) five-year annual average available from the Scottish Cancer Registry. Death certificate only cases have been excluded. Cases that have been diagnosed in the private sector but received any treatment in NHS hospitals have been included. Results must be interpreted with caution as Cancer Registry data includes all ovarian cancers whereas the QPI dataset includes only epithelial ovarian cancers. Age at Diagnosis Age of patients at diagnosis: n = 126 All patients Age at diagnosis Borders D&G Fife Lothian SCAN < > TOTAL SCAN Comparative Ovarian Cancer Report SA Ov02/16-9 -

10 QPI 1 Risk of Malignancy Index recorded in the patient notes Proportion of patients with Stage1 epithelial ovarian cancer having RMI assessed and recorded in their notes prior to any definitive surgical intervention. Target: 90% N: Number of patients with FIGO Stage 1 epithelial ovarian cancer having RMI score recorded in their notes prior to any definitive surgical intervention. D: All patients with FIGO Stage 1 epithelial ovarian cancer undergoing definitive surgical intervention. Exclusions: Patients presenting for surgery as an emergency. Target: 90% Ineligible for this QPI Numerator Denominator % Recorded 33.3% 25.0% 25.0% 8.3% 17.4% RMI should be recorded prior to the MDM. RMI calculation in patients with CA125 over 200 is not required so they should be excluded from this QPI. (1 patient in BGH) Action: Include box to record RMI on MDM referral form The 11 Lothian cases have been reviewed: 1 case was incorrectly classified as stage 1 (actually stage II fallopian tube) 1 had no suspicion of malignancy pre-op with a normal CA125. The remaining cases all had CA125 and imaging therefore the RMI could have been calculated. However, 4 cases had a CA125 of over 200, so RMI calculation is not clinically relevant and 3 cases were calculated as >200. All suspicious cases were operated on by gynaecological oncology specialists. SCAN Comparative Ovarian Cancer Report SA Ov02/

11 QPI2 Extent of disease assessed by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) prior to treatment Proportion of patients with epithelial ovarian cancer having a CT scan or MRI of the abdomen and pelvis performed to exclude the presence of metastatic disease prior to starting definitive treatment. Target: 90% N: Number of patients with epithelial ovarian cancer having a CT scan or MRI of the abdomen and pelvis carried out prior to starting treatment. D: All patients with epithelial ovarian cancer. Exclusions: Patients who decline to undergo investigation. Patients presenting for surgery as an emergency. Target: 90% Ineligible for this QPI Numerator Denominator % Recorded 100.0% 100.0% 96.2% 98.5% 98.3% No action required, QPI was met by all Boards. SCAN Comparative Ovarian Cancer Report SA Ov02/

12 QPI 3: Treatment planned and reviewed at a multi-disciplinary team meeting Proportion of patients with epithelial ovarian cancer who are discussed at a MDT meeting before definitive treatment. Target: 95% N: Number of patients with epithelial ovarian cancer discussed at the MDT before definitive treatment. D: All patients with epithelial ovarian cancer. Exclusions: Patients who died before first treatment. Target 95% Ineligible for this QPI Numerator Denominator % Recorded 81.8% 87.5% 77.8% 81.7% 81.6% BGH: 1 patient pre-operatively thought to be benign, 1 had emergency surgery Lothian: 12 patients had treatment before MDM, 3 of whom had emergency surgery and a further 2 were pre-operatively thought to be benign. 1 patient had urgent chemo before being discussed. A further 6 had surgery prior to MDM discussion and have been reviewed. Fife: 1 was an incidental finding, 1 had low RMI, 3 had theatre availability prior to MDM, 1 had emergency treatment D&G: 1 patient was referred to palliative care and not referred to gynae MDM. 1 had emergency surgery Action: Lothian surgical patients were reviewed and no further action was identified. SCAN Comparative Ovarian Cancer Report SA Ov02/

13 QPI 4i - Patients with early stage disease have an adequate staging operation Target = 95% Numerator = Number of early stage (FIGO Stage 1) epithelial ovarian cancer patients having primary surgery involving TAH, BSO, omentectomy and washings. Denominator = All early stage (FIGO Stage 1) epithelial ovarian cancer patients undergoing primary surgery. Exclusions = Patients having fertility conserving surgery. Patients with risk of malignancy index <200. Patients presenting for emergency surgery By Board of Diagnosis Target = 95% Ineligible for this QPI Numerator Denominator Not Recorded for Exclusions % Recorded 100.0% 100.0% 100.0% 76.9% 86.4% By Board of surgery Target = 95% Ineligible for this QPI Numerator Denominator Not Recorded for Exclusions % Recorded 100.0% 100.0% 100.0% 78.6% 86.4% Lothian comment: 1 patient was operated on by bowel specialist and was an incidental finding during bowel surgery No action required SCAN Comparative Ovarian Cancer Report SA Ov02/

14 QPI 4ii - Patients with early stage disease have an adequate staging operation Target = 95% Numerator = Number of early stage (FIGO Stage 1) epithelial ovarian cancer patients having primary surgery involving TAH, BSO, omentectomy and washings. Denominator = All early stage (FIGO Stage 1) epithelial ovarian cancer patients operated on by a gynaecological oncologist. Exclusions = Patients having fertility conserving surgery. Patients with risk of malignancy index <200. Patients presenting for emergency surgery By Board of diagnosis Target = 95% Ineligible for this QPI Numerator Denominator Not Recorded for Exclusions % Recorded 100.0% 100.0% 100.0% 100.0% 100.0% By Board of Surgery Target = 95% Ineligible for this QPI Numerator Denominator Not Recorded for Exclusions % Recorded 100.0% 100.0% 100.0% 100.0% 100.0% This QPI was met by all Boards. No action required SCAN Comparative Ovarian Cancer Report SA Ov02/

15 QPI 5i - No macroscopic residual disease following surgery for advanced disease Target = 30% Numerator = Number of patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) with no macroscopic residual disease following surgery. Denominator = All patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) undergoing surgery. Exclusions = Patients with FIGO Stage 4 disease. By Board of Diagnosis Target = 30% Ineligible for this QPI Numerator Not Recorded for Numerator Denominator % Recorded 75.0% 66.7% 53.3% 41.0% 47.5% By Board of Surgery Target = 30% Ineligible for this QPI Numerator Not Recorded for Numerator Denominator % Recorded 75.0% 50.0% 53.3% 42.5% 47.5% This QPI was met by all Boards. SCAN Comparative Ovarian Cancer Report SA Ov02/

16 QPI 5ii - No macroscopic residual disease following surgery for advanced disease Target = 60% Numerator = Number of patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) undergoing surgery with macroscopic residual disease < 1cm. Denominator = All patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) undergoing surgery. Exclusions = Patients with FIGO Stage 4 disease. By Board of Diagnosis Target = 60% Ineligible for this QPI Numerator Not Recorded for Numerator Denominator % Recorded 100.0% 66.7% 86.7% 59.0% 68.9% By Board of Surgery Target = 60% Ineligible for this QPI Numerator Not Recorded for Numerator Denominator % Recorded 100.0% 50.0% 86.7% 60.0% 68.9% D&G comment: small numbers make percentages unstable Lothian Action: Review patients with residual disease 5cm or more SCAN Comparative Ovarian Cancer Report SA Ov02/

17 QPI 6 - Histopathology reports are complete and support clinical decision-making Target = 90% Numerator = Number of patients with epithelial ovarian cancer undergoing definitive cytoreductive surgery who have a complete pathology report that contains all data items as defined by the Royal College of Pathologists. Denominator = All patients with epithelial ovarian cancer undergoing definitive cytoreductive surgery. Exclusions = No exclusions By Board of Diagnosis Target = 90% Ineligible for this QPI Numerator Denominator % Recorded 83.3% 100.0% 81.0% 91.7% 89.2% By Board of Surgery Target = 90% Ineligible for this QPI Numerator Denominator % Recorded 83.3% 100.0% 81.0% 94.2% 90.4% Fife: 4 failures were due to surgical sampling rather than pathology reporting Lothian had 4 failures where the pathology report was unclear, a proforma with all the Royal College items required would be helpful Action: SCAN Pathologists to use pro-forma for pathology reporting SCAN Comparative Ovarian Cancer Report SA Ov02/

18 QPI 7i - Histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy Target = 100% Numerator = Number of patients having histo/cytological diagnosis of epithelial ovarian cancer recorded prior to starting chemotherapy. Denominator = All patients with epithelial ovarian cancer undergoing neo-adjuvant chemotherapy. Exclusions = Patients for whom paracentesis, image-guided biopsy or laparoscopy is considered not suitable Target = 100% Ineligible for this QPI Numerator Denominator % Recorded NA 100.0% 100.0% 100.0% 100.0% This QPI was met by all Boards. No action required. SCAN Comparative Ovarian Cancer Report SA Ov02/

19 QPI 7ii - Histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy Target = 80% Numerator = Number of patients who have a diagnosis of epithelial ovarian cancer confirmed by histology prior to starting chemotherapy. Denominator = All patients with epithelial ovarian cancer having histo/cytological diagnosis recorded prior to starting neo-adjuvant chemotherapy. Exclusions = No exclusions Target = 80% Ineligible for this QPI Numerator Denominator % Recorded NA 100.0% 100.0% 76.9% 83.3% Lothian: All 6 fails were thought to be high grade serous carcinoma on immunocytology. All were confirmed as high grade serous carcinoma at definitive operation. All were treated appropriately as there was no change in pathology once full resection tissue was sampled. No action required SCAN Comparative Ovarian Cancer Report SA Ov02/

20 QPI 8i - Delayed primary surgery Target = 75% Numerator = Number of patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) undergoing delayed primary surgery after neo-adjuvant chemotherapy. Denominator = All patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) having neo-adjuvant chemotherapy. Exclusions = No exclusions Target = 75% Ineligible for this QPI Numerator Denominator % Recorded NA 50.0% 83.3% 77.3% 75.0% D&G: 2 patients progressed on chemo Fife: 1 patient progressed on chemo Lothian: 1 patient progressed on chemo, 1 had comorbidities and 3 were unresectable No action required SCAN Comparative Ovarian Cancer Report SA Ov02/

21 QPI 8ii - Delayed primary surgery Residual Disease Target = 65% Numerator = Number of patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) undergoing delayed primary surgery with residual disease <1cm. Denominator = All patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) undergoing delayed primary surgery after neo-adjuvant chemotherapy. Exclusions = No exclusions Target = 65% Ineligible for this QPI Numerator Not Recorded for Numerator Denominator % Recorded NA 100.0% 100.0% 82.4% 87.5% All Boards met this QPI. Comment: This is an excellent result. SCAN Comparative Ovarian Cancer Report SA Ov02/

22 QPI 9 - First-line Chemotherapy Target = 90% Numerator = Number of epithelial ovarian cancer patients who receive chemotherapy treatment involving either paclitaxel in combination with a platinumbased compound or carboplatin only Denominator = All epithelial ovarian cancer patients Exclusions = Patients with low-grade serous disease. Patients with FIGO stage 1a or 1b, low grade (G1) disease. Patients with Stage 1a clear cell tumours. Patients who decline chemotherapy treatment. Target = 90% Ineligible for this QPI Numerator Denominator Not Recorded for Exclusions % Recorded 77.8% 80.0% 95.8% 85.7% 86.5% An analysis of the 15 patients that missed QPI 9 shows that this was in main due to frailty from the cancer (9) or frailty from comorbidities (3). 1 patient had stage IC1 low grade mucinous tumour, which is not an exclusion, but is not chemosensitive. 2 patients had decided against further treatment and were not seen by oncology Reasons for no chemotherapy given BGH D&G Fife Lothian SCAN Patient too unwell at diagnosis/post operatively Due to comorbidities 3 3 Low grade/risk disease (grade 1) (mucinous) 1 1 Other 2 2 Total No action required SCAN Comparative Ovarian Cancer Report SA Ov02/

23 Ovarian Cancer Glossary of Terms Adenocarcinoma A malignant growth of glandular tissue, adenocarcinoma can develop in any gynaecological organ. Adjuvant treatment Treatment used in addition to main treatment, usually chemotherapy given after surgery. Adnexal mass Mass of tissue on or in a structure associated with the uterus such as an ovary, fallopian tube, or uterine ligament. ARDS Acute Respiratory Distress Syndrome Ascites An accumulation of fluid in the abdominal (peritoneal) cavity. Audit A method by which those involved in providing services assess the quality of care. Results of a process or intervention are assessed, compared with a pre-existing standard, changed where necessary, then reassessed. BACiL Better Acute Care in Lothian Bevacizumab A drug that slows the growth of new blood vessels Biopsy Removal of a sample of tissue or cells from the body to assist in diagnosis of a disease. Borderline Tumour Tumours of low malignant potential based on the microscopic appearance of the cancer. They are expected to behave as very low grade cancers, i.e., to be very slow growing Carcinoma A cancerous growth. CA125 A substance which may be found in the blood of women who have ovarian cancer, used as a biochemical marker for the disease. Chemotherapy The use of drugs that kill cancer cells, or prevent or slow their growth. Cytology The study of the appearance of individual cells under a microscope. Cytotoxic Toxic to cells. This term is used to describe drugs which kill cancer cells or slow their growth. Debulking Removal by surgery of a substantial proportion of cancer tissue. Optimal debulking refers to the removal of the largest possible amount of cancer while limiting damage to normal tissue Delayed primary surgery (DPS) Previously referred (to in this report) as interval debulking, refers to surgical removal of tumour after chemotherapy aimed at further reducing its bulk. Differentiation The degree of morphological resemblance between cancer tissue and the tissue from which the cancer developed. Exenterative surgery Removal of the pelvic organs including the uterus, ovaries and associated organs and the bladder and/or large bowel. SCAN Comparative Ovarian Cancer Report SA Ov02/16 23

24 FIGO International Federation of Gynaecology and Obstetrics. FIGO defines staging in gynaecological cancer and collates information about treatment and survival from a group of collaborating European centres (including some in the UK). Gynaecology The branch of medicine which deals with the female reproductive organs. Histological grade Degree of malignancy of a tumour, usually judged from its histological features. Histological type The type of tissue found in a tumour. Histology Examination of the microscopic structure of tissue. Hysterectomy Surgical removal of the uterus. Lymph nodes Small organs which act as filters in the lymphatic system. Lymph nodes close to the primary tumour are often the first sites to which cancer spreads. Lymphadenectomy Surgical removal of lymph nodes. Lymphadenopathy Disease of the lymph nodes. Magnetic resonance imaging (MRI) A non-invasive method of imaging which allows the form and metabolism of tissues and organs to be visualised. Medical Oncologist A doctor who specialises in the treatment of cancer through the use of chemotherapy. Metastases Spread of cancer away from the primary site. meoc A trial looking at chemotherapy with or without bevacizumab for mucinous ovarian cancer Multidisciplinary Team (MDT) A multiprofessional group of people consisting of several specialties and disciplines who work together to provide care for patients with a particular condition NCEPOD National Confidential Enquiry into Patient Outcome and Death Neo-adjuvant treatment Treatment given before the main treatment; usually chemotherapy given before surgery. Nodes See Lymph nodes. Non-neoplastic Tissue that does not contain tumour. Omentectomy Surgical removal of the omentum, a large fold of visceral peritoneum. Oncologist A doctor who specialises in treating cancer. Oncology The study of the biology and physical and chemical features of cancers. Also the study of the causes and treatment of cancers. Oophorectomy Removal of the ovaries. Palliative Anything which serves to alleviate symptoms due to the underlying cancer but is not expected to cure it. Hence palliative care, palliative chemotherapy. Peritoneal washings Fluid taken from the abdominal (peritoneal) cavity during surgery. SCAN Comparative Ovarian Cancer Report SA Ov02/16 24

25 PETROC A trial comparing different combinations of chemotherapy after surgery for women with ovarian cancer who have already had chemotherapy before surgery Primary Peritoneal Cancer A tumour which shows similar morphological characteristics to ovarian cancer but which has no or minimal ovarian involvement Prophylaxis An intervention used to prevent an unwanted outcome. Protocol A policy or strategy which defines appropriate action. Resection The surgical removal of all or part of an organ. Risk of Malignancy Index (RMI) A measure of the risk of a harmful tumour, based on combining the results of transvaginal ultrasound examination, menopausal status and blood levels of the ovarian cancer marker CA125 (measured in U/ml) Staging The allocation of categories (stage I to IV) to tumours defined by internationally agreed criteria. Stage I tumours are localised, whilst stages II to IV refer to increasing degrees of spread through the body from the primary site. Tumour stage is an important determinant of treatment and prognosis. Surgical stages of ovarian cancer Stage I IA IB IC Stage II IIA IIB IIC Stage III IIIA IIIB IIIC Stage IV Limited to the ovaries One ovary involved Both ovaries involved One or both ovaries involved, but with cancer on the surface of an ovary, rupture of an ovarian cyst malignant ascites or positive abdominal washings Spread to adjacent pelvic structures Spread to uterus or fallopian tubes Spread to pelvic peritoneum Confined to the pelvis, but with malignant ascites or positive abdominal washings Spread to the upper abdomen Microscopic spread to the upper abdomen Cancer nodules less than 2 cm in the abdomen Nodules more than 2 cm, or positive pelvic or aortic lymph nodes Distant spread beyond the abdomen, liver, lung etc Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BS0) Removal of the uterus with both fallopian tubes and ovaries through an incision in the abdomen. Ultrasound High-frequency sound waves used to create images of structures and organs within the body. SCAN Comparative Ovarian Cancer Report SA Ov02/16 25