Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Ovarian Cancer | Research article

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

Authors: Kahren M. White, Holly Seale, Reema Harrison

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

Clinical variation in ovarian cancer care has been reported internationally. Using Wennberg’s classification of clinical variation as effective care we can conceptualise variation through deviation from clinical guidelines. The aim of this review was to address knowledge gaps in the effectiveness of attempts to reduce unwarranted clinical variation through addressing the following questions: What is the evidence of guideline adherence in ovarian cancer and its deviation?; what are the key factors associated with variation in guideline adherence in ovarian cancer care?; and what quality improvement approaches have been used and what is the evidence of their effectiveness in enhancing guideline adherence in ovarian cancer care?.

Methods

Keywords and synonyms for the major concepts of ovarian cancer, guideline adherence and safety were developed and combined to form the search strategy. Systematic searches of four electronic databases were undertaken of publications from January 2007 to November 2018. Retrieved articles were assessed against the eligibility criteria to determine those for inclusion.

Results

Thirty-two papers were included in the review with three broad groupings identified: adherence to and deviation from guidelines (either local, national or international guidelines); factors impacting guidelines adherence; and quality improvement approaches.

Conclusions

Unwarranted clinical variation may be used as a marker for the effectiveness of a health system, based on the outcome of this systematic review. This review found that the implementation of quality indicators through a formal quality improvement program lead to improvements in guideline adherent care. Further research on outcomes of implementing quality improvement programs in ovarian cancer care will improve the ability to implement centralised care and further identify factors that to improve outcomes in ovarian cancer care.
Appendix
Available only for authorised users
Literature
1.
Harrison R, Manias E, Mears S, Heslop D, Hinchcliff R, Hay L. Addressing unwarranted clinical variation: a rapid review of current evidence. J Eval Clin Pract. 2018;25(1):52–65.
2.
Barber EL, Dusetzina SB, Stitzenberg KB, Rossi EC, Gehrig PA, Boggess JF, et al. Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival. Gynecol Oncol. 2017;145(3):500–7.PubMedPubMedCentral
3.
Dodge JE. Epithelial ovarian cancer surgical staging by Ontario gynaecologic surgeons: is there a gap between current practice and the Canadian clinical practice guidelines? J Obstet Gynaecol Can. 2007;29(8):653–63.PubMed
4.
Jordan S, Steer C, DeFazio A, Quinn M, Obermair A, Friedlander M, et al. Patterns of chemotherapy treatment for women with invasive epithelial ovarian cancer - a population-based study. Gynecol Oncol. 2013;129:310–7.PubMed
5.
Jordan SJ, Francis JE, Nelson AE, Zorbas HM, Luxford KA, Webb PM. Pathways to the diagnosis of epithelial ovarian cancer in Australia. Med J Aust. 2010;193(6):326–30.PubMed
6.
Institute of Medicine. Preventing medical errors. Washington, DC: National Academies Press; 2006.
7.
Wennberg JE. Unwarranted variations in healthcare delivery: implications for academic medical Centres. BMJ: British Medical Journal. 2002;325(7370):961–4.PubMedPubMedCentral
8.
Wennberg J. Time to tackle unwarranted variations in practice. BMJ: British Medical Journal. 2011;342(7799):687–90.
9.
National Comprehensive Cancer Network. NCCN Guidelines: Version 4.2017 Ovarian cancer 2017.
10.
National Institute for Health and Clinical Excellence. Recognition and initial management of ovarian cancer. 2011.
11.
Ledermann JA, Raja FA, Fotopoulou C, Gonzalez-Martin A, Colombo N, Sessa C, et al. Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(suppl 6):vi24–32.PubMed
12.
Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: enhanced recovery after surgery (ERAS(R)) society recommendations--part I. Gynecol Oncol. 2016;140(2):313–22.PubMed
13.
Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for postoperative care in gynecologic/oncology surgery: enhanced recovery after surgery (ERAS®) society recommendations--part II. Gynecol Oncol. 2016;140(2):323–32.PubMedPubMedCentral
14.
Moher D, Liberati A, Tetzlaff J, Altman DG, The PG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):e1000097.PubMedPubMedCentral
15.
Woo YL, Kyrgiou M, Bryant A, Everett T, Dickinson HO. Centralisation of services for gynaecological cancers. Cochrane Database of Syst Rev. 2012;3:CD007945.
16.
Popay J, Roberts HM, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. London: Institute for Health Research; 2006.
17.
Bristow RE, Chang J, Ziogas A, Anton-Culver H. Adherence to treatment guidelines for ovarian cancer as a measure of quality care. Obstet Gynecol. 2013;121(6):1226–34.PubMed
18.
Chan JK, Kapp DS, Shin JY, Osann K, Leiserowitz GS, Cress RD, et al. Factors associated with the suboptimal treatment of women less than 55 years of age with early-stage ovarian cancer. Gynecol Oncol. 2008;108(1):95–9.PubMed
19.
Erickson BK, Martin JY, Shah MM, Straughn JM Jr, Leath CA 3rd. Reasons for failure to deliver National Comprehensive Cancer Network (NCCN)-adherent care in the treatment of epithelial ovarian cancer at an NCCN cancer center. Gynecol Oncol. 2014;133(2):142–6.PubMedPubMedCentral
20.
Galvan-Turner VB, Chang J, Ziogas A, Bristow RE. Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for ovarian cancer. Gynecol Oncol. 2015;139(3):495–9.PubMedPubMedCentral
21.
Hodeib M, Chang J, Liu F, Ziogas A, Dilley S, Randall LM, et al. Socioeconomic status as a predictor of adherence to treatment guidelines for early-stage ovarian cancer. Gynecol Oncol. 2015;138(1):121–7.PubMedPubMedCentral
22.
Lee JY, Kim TH, Suh DH, Kim JW, Kim HS, Chung HH, et al. Impact of guideline adherence on patient outcomes in early-stage epithelial ovarian cancer. Eur J Surg Oncol. 2015;41(4):585–91.PubMed
23.
Phippen NT, Barnett JC, Lowery WJ, Miller CR, Leath CA 3rd. Surgical outcomes and national comprehensive cancer network compliance in advanced ovarian cancer surgery in a low volume military treatment facility. Gynecol Oncol. 2013;131(1):158–62.PubMed
24.
Sijmons EA, van Lankveld MA, Witteveen PO, Peeters PHM, Koot VCM, van Leeuwen JS. Compliance to clinical guidelines for early-stage epithelial ovarian cancer in relation to patient outcome. Eur J Obstet Gynecol Reprod Biol. 2007;131(2):203–8.PubMed
25.
Sobrero S, Pagano E, Piovano E, Bono L, Ceccarelli M, Ferrero A, et al. Is ovarian cancer being managed according to clinical guidelines? Evidence from a population-based clinical audit. Int J Gynecol Cancer. 2016;26(9):1615–23.PubMed
26.
Warren J, Harlan LC, Trimble EL, Stevens J, Grimes M, Cronin KA. Trends in the receipt of guideline care and survival for women with ovarian cancer. J Clin Oncol Conference. 2017;35(15 Supplement 1).
27.
Bristow RE, Puri I, Diaz-Montes TP, Giuntoli RL, Armstrong DK. Analysis of contemporary trends in access to high-volume ovarian cancer surgical care. Ann Surg Oncol. 2009;16(12):3422–30.PubMed
28.
Bristow RE, Zahurak ML, Diaz-Montes TP, Giuntoli RL, Armstrong DK. Impact of surgeon and hospital ovarian cancer surgical case volume on in-hospital mortality and related short-term outcomes. Gynecol Oncol. 2009;115(3):334–8.PubMed
29.
Bristow RE, Palis BE, Chi DS, Cliby WA. The National Cancer Database report on advanced-stage epithelial ovarian cancer: impact of hospital surgical case volume on overall survival and surgical treatment paradigm. Gynecol Oncol. 2010;118(3):262–7.PubMed
30.
Cliby WA, Powell MA, Al-Hammadi N, Chen L, Miller JP, Roland PY, et al. Ovarian cancer in the United States: contemporary patterns of care associated with improved survival. Gynecol Oncol. 2015;136(1):11–7.PubMed
31.
Ivanova V, Dikov T, Dimitrova N. Histologic subtypes of ovarian carcinoma: selected diagnostic and classification problems in Bulgaria: is low hospital volume an issue? Tumori Journal. 2017;103(2):148–54.PubMed
32.
Mandato VD, Abrate M, De Iaco P, Pirillo D, Ciarlini G, Leoni M, et al. Clinical governance network for clinical audit to improve quality in epithelial ovarian cancer management. J Ovarian Res. 2013;6(1):19.PubMedPubMedCentral
33.
Shakeel S, Elit L, Akhtar-Danesh N, Schneider L, Finley C. Care delivery patterns, processes, and outcomes for primary ovarian cancer surgery: a population-based review using a national administrative database. J Obstet Gynaecol Can. 2017;39(1):25–33.PubMed
34.
Wright JD, Herzog TJ, Siddiq Z, Arend R, Neugut AI, Burke WM, et al. Failure to rescue as a source of variation in hospital mortality for ovarian Cancer. J Clin Oncol. 2012;30(32):3976–82.PubMed
35.
Wright JD, Neugut AI, Lewin SN, Lu YS, Herzog TJ, Hershman DL. Trends in hospital volume and patterns of referral for women with gynecologic cancers. Obstet Gynecol. 2013;121(6):1217–25.PubMedPubMedCentral
36.
Marth C, Hiebl S, Oberaigner W, Winter R, Leodolter S, Sevelda P. Influence of department volume on survival for ovarian cancer: results from a prospective quality assurance program of the Austrian Association for Gynecologic Oncology. Int J Gynecol Cancer. 2009;19(1):94–102.PubMed
37.
Uppal S, Spencer RJ, Rice LW, del Carmen MG, Reynolds RK, Griggs JJ. Hospital readmission as a poor measure of quality in ovarian Cancer surgery. Obstet Gynecol. 2018;132(1):126–36.PubMed
38.
Wright JD, Chen L, Hou JY, Burke WM, Tergas AI, Ananth CV, et al. Association of Hospital Volume and Quality of care with survival for ovarian Cancer. Obstet Gynecol. 2017;130(3):545–53.PubMedPubMedCentral
39.
Aletti GD, Dowdy SC, Gostout BS, Jones MB, Stanhope RC, Wilson TO, et al. Quality improvement in the surgical approach to advanced ovarian cancer: The Mayo Clinic experience. J Am Coll Surg. 2009;208(4):614–20.PubMed
40.
Aletti GD, Peiretti M. Quality control in ovarian cancer surgery. Best Pract Res Clin Obstet Gynaecol. 2017;41:96–107.PubMed
41.
Harter P, Muallem ZM, Buhrmann C, Lorenz D, Kaub C, Hils R, et al. Impact of a structured quality management program on surgical outcome in primary advanced ovarian cancer. Gynecol Oncol. 2011;121(3):615–9.PubMed
42.
Kommoss S, Harter P, Traut A, Strutas D, Riegler N, Buhrmann C, et al. Compliance to consensus recommendations, surgeon's experience, and introduction of a quality assurance and management program influence on therapy of early-stage ovarian carcinoma. Int J Gynecol Cancer. 2009;19(4):787–93.PubMed
43.
Liang MI, ElNaggar AC, Nekkanti S, O'Malley DM, Hade EM, Copeland LJ, et al. Setting the bar: compliance with ovarian cancer quality indicators at a National Cancer Institute-designated Comprehensive Cancer Center. Gynecol Oncol. 2015;138(3):689–93.PubMed
44.
Phillips A, Balega J, Nevin J, Singh K, Elattar A, Kehoe S, et al. Reporting 'Denominator' data is essential for benchmarking and quality standards in ovarian cancer. Gynecol Oncol. 2017;146(1):94–100.PubMed
45.
Querleu D, Planchamp F, Chiva L, Fotopoulou C, Barton D, Cibula D, et al. European society of gynaecologic oncology quality indicators for advanced ovarian cancer surgery. Int J Gynecol Cancer. 2016;26(7):1354–63.PubMed
46.
Verleye L, Ottevanger PB, van der Graaf W, Reed NS, Vergote I. EORTC-GCG process quality indicators for ovarian cancer surgery. Eur J Cancer. 2009;45(4):517–26.PubMed
47.
Querleu D, Ray-Coquard I, Classe JM, Aucouturier JS, Bonnet F, Bonnier P, et al. Quality indicators in ovarian cancer surgery: report from the french society of gynecologic oncology (Société Française d'Oncologie Gynécologique, SFOG). Ann Oncol. 2013;24(11):2732–9.PubMed
48.
Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979;301(25):1364–9.PubMed
49.
Uppal S, Rice LW, Beniwal A, Spencer RJ. Trends in hospice discharge, documented inpatient palliative care services and inpatient mortality in ovarian carcinoma. Gynecol Oncol. 2016;143(2):371–8.PubMed
50.
Coupland VH, Konfortion J, Jack RH, Allum W, Kocher HM, Riaz SP, et al. Resection rate, hospital procedure volume and survival in pancreatic cancer patients in England: population-based study, 2005-2009. Eur J Surg Oncol. 2016;42(2):190–6.PubMed
51.
Fung-Kee-Fung M, Kennedy EB, Biagi J, Colgan T, D'Souza D, Elit L, et al. An organisational guideline for gynecologic oncology services. Int J Gynecol Cancer. 2015;25(4):551–8.PubMed
52.
Huguet M, Perrier L, Bally O, Benayoun D, De Saint HP, Beal Ardisson D, et al. Being treated in higher volume hospitals leads to longer progression-free survival for epithelial ovarian carcinoma patients in the Rhone-Alpes region of France. BMC Health Serv Res. 2018;18(1):3.PubMedPubMedCentral
53.
Calman K, Hine D. A policy framework for commissioning Cancer services: a report to the chief medical officers of England and Wales. London: Department of Health; 1995.
54.
Aune G, Torp SH, Syversen U, Hagen B, Tingulstad S. Ten years' experience with centralized surgery of ovarian cancer in one health region in Norway. Int J Gynecol Cancer. 2012;22(2):226–31.PubMed
55.
Chan JK, Kapp DS, Shin JY, Husain A, Teng NN, Berek JS, et al. Influence of the gynecologic oncologist on the survival of ovarian cancer patients. Obstet Gynecol. 2007;109(6):1342–50.PubMed
Metadata
Title
Enhancing ovarian cancer care: a systematic review of guideline adherence and clinical variation
Authors
Kahren M. White
Holly Seale
Reema Harrison
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-6633-4

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue

Research article

Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: a meta-analysis

Research article

Supportive needs of women who have experienced pregnancy termination due to fetal abnormalities: a qualitative study from the perspective of women, men and healthcare providers in Iran

Research article

Acceptability and understanding of front-of-pack nutritional labels: an experimental study in Mexican consumers

Research article

Foot-based audit of streets adjacent to new light rail stations in Houston, Texas: measurement of health-related characteristics of the built environment for physical activity research

Research article

Psychometric properties of fertility desire scale (FDS) developed for Iranian parents

Research article

The impact of data quality and source data verification on epidemiologic inference: a practical application using HIV observational data