TY - JOUR

T1 - Exploring international differences in ovarian cancer treatment

T2 - A comparison of clinical practice guidelines and patterns of care

AU - Norell, Charles H.

AU - Butler, John

AU - Farrell, Rhonda

AU - Altman, Alon

AU - Bentley, James

AU - Cabasag, Citadel J.

AU - Cohen, Paul A.

AU - Fegan, Scott

AU - Fung-Kee-Fung, Michael

AU - Gourley, Charlie

AU - Hacker, Neville F.

AU - Hanna, Louise

AU - Høgdall, Claus Kim

AU - Kristensen, Gunnar

AU - Kwon, Janice

AU - McNally, Orla

AU - Nelson, Gregg

AU - Nordin, Andy

AU - O'Donnell, Dearbhaile

AU - Schnack, Tine

AU - Sykes, Peter H.

AU - Zotow, Ewa

AU - Harrison, Samantha

PY - 2020

Y1 - 2020

N2 - Introduction The International Cancer Benchmarking Partnership demonstrated international differences in ovarian cancer survival, particularly for women aged 65-74 with advanced disease. These findings suggest differences in treatment could be contributing to survival disparities. Objective To compare clinical practice guidelines and patterns of care across seven high-income countries. Methods A comparison of guidelines was performed and validated by a clinical working group. To explore clinical practice, a patterns of care survey was developed. A questionnaire regarding management and potential health system-related barriers to providing treatment was emailed to gynecological specialists. Guideline and survey results were crudely compared with 3-year survival by 'distant' stage using Spearman's rho. Results Twenty-seven guidelines were compared, and 119 clinicians completed the survey. Guideline-related measures varied between countries but did not correlate with survival internationally. Guidelines were consistent for surgical recommendations of either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery with the aim of complete cytoreduction. Reported patterns of surgical care varied internationally, including for rates of primary versus interval debulking, extensive/' ultra-radical' surgery, and perceived barriers to optimal cytoreduction. Comparison showed that willingness to undertake extensive surgery correlated with survival across countries (r s =0.94, p=0.017). For systemic/radiation therapies, guideline differences were more pronounced, particularly for bevacizumab and PARP (poly (ADP-ribose) polymerase) inhibitors. Reported health system-related barriers also varied internationally and included a lack of adequate hospital staffing and treatment monitoring via local and national audits. Discussion Findings suggest international variations in ovarian cancer treatment. Characteristics relating to countries with higher stage-specific survival included higher reported rates of primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.

AB - Introduction The International Cancer Benchmarking Partnership demonstrated international differences in ovarian cancer survival, particularly for women aged 65-74 with advanced disease. These findings suggest differences in treatment could be contributing to survival disparities. Objective To compare clinical practice guidelines and patterns of care across seven high-income countries. Methods A comparison of guidelines was performed and validated by a clinical working group. To explore clinical practice, a patterns of care survey was developed. A questionnaire regarding management and potential health system-related barriers to providing treatment was emailed to gynecological specialists. Guideline and survey results were crudely compared with 3-year survival by 'distant' stage using Spearman's rho. Results Twenty-seven guidelines were compared, and 119 clinicians completed the survey. Guideline-related measures varied between countries but did not correlate with survival internationally. Guidelines were consistent for surgical recommendations of either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery with the aim of complete cytoreduction. Reported patterns of surgical care varied internationally, including for rates of primary versus interval debulking, extensive/' ultra-radical' surgery, and perceived barriers to optimal cytoreduction. Comparison showed that willingness to undertake extensive surgery correlated with survival across countries (r s =0.94, p=0.017). For systemic/radiation therapies, guideline differences were more pronounced, particularly for bevacizumab and PARP (poly (ADP-ribose) polymerase) inhibitors. Reported health system-related barriers also varied internationally and included a lack of adequate hospital staffing and treatment monitoring via local and national audits. Discussion Findings suggest international variations in ovarian cancer treatment. Characteristics relating to countries with higher stage-specific survival included higher reported rates of primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.

KW - medical oncology

KW - ovarian cancer

KW - surgery

KW - surgical oncology

U2 - 10.1136/ijgc-2020-001403

DO - 10.1136/ijgc-2020-001403

M3 - Journal article

C2 - 32784203

AN - SCOPUS:85090790879

VL - 30

SP - 1748

EP - 1756

JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

SN - 1048-891X

IS - 11

ER -