OBJECTIVE:
To
evaluate the impact of the 1999 national recommendations for ovarian
cancer surgery in England to be performed by specialist surgeons in
specialist centres.
METHODS:
A
retrospective analysis of English cancer registry records, Hospital
Episode Statistics (HES) data for all English NHS providers and General
Medical Council (GMC) sub-specialty accreditation, to consider changes
to the annual proportion of ovarian cancer (ICD10 C56-C57) patients
undergoing major gynaecological surgery in gynaecological cancer centres
(GCCs) or by specialist gynaecological oncologists (GOs).
RESULTS:
From
2000 to 2009, 2,428 consultants were responsible for surgery on 30,753
patients. There were significant increases in the proportions of
patients undergoing surgery at GCCs (43% to 76%, P<0.001), by GMC
accredited GOs (5% to 36%, P<0.001), and by high ovarian cancer
caseload (≥18 cases) surgeons (22% to 56%, P<0.001).
CONCLUSION:
There
has been increased centralisation and specialisation of surgery for
ovarian cancer patients since the NHS Cancer Plan (2000) and there has
also been improved survival. However, by 2009, many ovarian cancer
patients were still not receiving specialist surgery; the majority of
patients were not operated on by GMC accredited gynaecological
oncologists and there was considerable regional variation. Systems of
accreditation should be reviewed and trusts should ensure HES data
accurately records clinical activity.
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