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abstract
Is Ovarian Cancer Being Managed According to Clinical Guidelines? Evidence From a Population-Based Clinical Audit
Conclusions: Results support the need to reorganize the clinical pathway of patients with OC in the Piedmont Region and the need for better adherence to current guidelines.
Background: In the northwestern Italian region of
Piedmont, current statistics on hospitalizations show that surgical
treatment for ovarian cancer (OC) is taking place in many small
hospitals, as opposed to a more centralized approach.
A population-based
clinical audit was promoted to investigate whether OC is being managed
according to clinical guidelines, identify determinants of lack of
adherence to guidelines, and evaluate the association between adherence
to guidelines and survival.
Patients and Methods: Residents diagnosed with OC in
2009 were identified in the regional hospital discharge records
database. All hospitalizations within 2 years from diagnosis were
reviewed. Patients were classified according to their initial pattern of
care, defined as “with curative intent” (CIPC) if including debulking
surgery aimed at maximal cytoreduction. Adherence to guidelines for
surgery and chemotherapy and the effects of this adherence on OC
survival were investigated with logistic regression and Cox models.
Results: The final study sample consisted of 344
patients with OC, 215 (62.5%) of whom received CIPC. Increasing age,
comorbidities, and metastases were negatively associated with receiving
CIPC. In the CIPC group, surgical treatment was adherent to guidelines
in 35.2%, whereas chemotherapy was adherent in 87.8%. Surgical treatment
that was adherent to guidelinesand absence of residual tumor were associated with better survival in the
CIPC group, and chemotherapy that was adherent to guidelines was
associated with a significant reduction in the risk of death.
Conclusions: Results support the need to reorganize
the clinical pathway of patients with OC in the Piedmont Region and the
need for better adherence to current guidelines.
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