Management and survival of ovarian cancer patients in south east England.

The aim of this study was to audit the effect of adherence to regionally developed guidelines on survival in women with ovarian cancer. A prospective audit of 118 newly diagnosed cases of ovarian cancer in seven district health authorities of South East Thames, U.K. was undertaken. Appropriateness of clinical investigation and management and survival by type of hospital were examined: 118 incident cases were registered in 1991 for the audit. The mean age of the women was 61.29 years (S.D. 14.24) (range 27-92). 25 (21%) were stage I, 15 (13%) stage II, 77 (66%) stage III/IV. 62 (53%) women had the appropriate pre-operative investigations and 75 (64%) were staged in the notes. Management took place in hospitals treating as few as 1 case a year. Overall, 47 (43%) women were appropriately managed which was influenced by type of hospital of surgery (19 (66%) teaching, 20 (45%) non-teaching with oncology support, 8 (28%) non-teaching (P = 0.02). 64 women (54% died by 1 June 1994) (mean follow-up 2.1 years) (minimum 2.41 years, maximum 3.41 years). In multiple regression analysis, death was significantly more likely in women who had been inappropriately managed, those with more advanced disease and those with postoperative complications. This audit indicates that despite the development of guidelines, investigation and management of ovarian cancer varied considerably between hospitals. Management of this cancer of intermediate incidence occurs in hospitals managing as few as 1 case per year. Pre-operative and operative management was inappropriate for the majority of women and this significantly influenced survival. These data have implications for the purchasing of cancer services for this disease.