Quality indicators for the management of epithelial ovarian cancer

357 p.ill.,SCIENTIFIC REPORT 23 -- 1 INTRODUCTION 23 -- 1.1 OVARIAN CANCER 24 -- 1.1.1 Background 24 -- 1.1.2 Epidemiology of ovarian cancer in Belgium 24 -- 1.2 DISPERSION OF CARE FOR OVARIAN CANCER IN BELGIUM 25 -- 1.3 MEASURING QUALITY 26 -- 2 OBJECTIVES AND SCOPE 27 -- 2.1 AIM OF THE STUDY 27 -- 2.2 SCOPE 27 -- 2.3 TARGET AUDIENCE 27 -- 3 METHODOLOGY 28 -- 3.1 STEP 1: IDENTIFICATION OF THE TARGET POPULATION: DATA SELECTION AND LINKAGE OF DATABASES 28 -- 3.1.1 Selection of the study population in the Belgian Cancer Registry database 28 -- 3.1.2 Linkage with health insurance data 30 -- 3.1.3 Vital status 31 -- 3.1.4 Pathology reports 31 -- 3.1.5 Data unavailable for assessment of quality indicators 31 -- 3.2 STEP 2: IDENTIFICATION AND SELECTION OF POSSIBLE QUALITY INDICATORS 31 -- 3.2.1 Identification of possible quality indicators 31 -- 3.2.2 Selection process and results 31 -- 3.2.3 Measurability of selected quality indicators 32 -- 3.2.4 Final selection of quality indicators to be fully elaborated 32 -- 3.3 STEP 3: OPERATIONALIZATION OF INDICATORS 34 -- 3.3.1 Technical fiches 35 -- 3.3.2 Defining diagnostic and therapeutic procedures 35 -- 3.3.3 Defining the treatment scheme of the patient 41 -- 3.3.4 Case-mix adjustment 41 -- 3.3.5 Statistical analysis 44 -- 3.4 STEP 4: ASSIGNMENT OF EACH PATIENT TO ONE CENTRE 47 -- 3.5 STEP 5: VALIDATION OF DIAGNOSTIC AND THERAPEUTIC DATA 50 -- 3.5.1 Introduction and methodology 50 -- 3.5.2 Results of the validation of the algorithm to assign each patient to one centre of first diagnosis and one centre of main treatment 51 -- 3.5.3 Validation of the patient and tumour characteristics and of diagnostic and therapeutic procedures 52 -- 3.5.4 Validation of the quality indicator results 56 -- 3.5.5 Conclusion 56 -- 4 CHARACTERISTICS OF THE STUDY COHORT 56 -- 4.1 BASELINE DEMOGRAPHICS AND TUMOUR CHARACTERISTICS 57 -- 4.2 MAIN DIAGNOSTIC PROCEDURES 57 -- 4.3 MAIN THERAPEUTIC PROCEDURES 58 -- 4.3.1 Surgical procedures 58 -- 4.3.2 Chemotherapy (including targeted therapy) 59 -- 4.3.3 Comprehensive treatment (TT01) 59 -- 4.3.4 Treatment schemes 59 -- 5 INDICATOR RESULTS 60 -- 5.1 QUALITY OF DIAGNOSIS AND STAGING IN EPITHELIAL OVARIAN CANCER 60 -- 5.1.1 Multidisciplinary team (MDT) meeting (DS01) 60 -- 5.1.2 Genetic testing (DS02) 62 -- 5.1.3 Cyto/histological diagnosis prior to starting chemotherapy (DS03) 65 -- 5.1.4 Minimal staging surgery (DS04) 67 -- 5.1.5 Abdomino-pelvic imaging prior to starting treatment (DS05) 70 -- 5.1.6 Lymph node removal in women with invasive I-IIA epithelial ovarian cancer (DS06) 72 -- 5.1.7 No lymphadenectomy in women with a borderline ovarian tumour (DS07) 74 -- 5.2 QUALITY OF TREATMENT IN EPITHELIAL OVARIAN CANCER 75 -- 5.2.1 Platinum-based chemotherapy, either in combination or as a single agent (CT01) 75 -- 5.2.2 Duration of platinum-based chemotherapy (CT02) 78 -- 5.2.3 Timeliness of chemotherapy (CT03) 82 -- 5.2.4 Timeliness of start of first treatment (TT02) 84 -- 5.2.5 Systemic treatment within 2 weeks of death (EOL) 86 -- 5.3 SAFETY OF CARE IN EPITHELIAL OVARIAN CANCER 88 -- 5.3.1 30-day post-operative complicated recovery (OS01) 88 -- 5.3.2 30-day post-operative mortality (OS02) 90 -- 5.4 1, 2 AND 5-YEAR OBSERVED AND RELATIVE SURVIVAL (OS03) 93 -- 5.5 ASSOCIATION BETWEEN HOSPITAL VOLUME AND OUTCOME 96 -- 5.5.1 Hospital main treatment volume and survival (VO01) 96 -- 5.5.2 Hospital surgical volume and outcome (VO02) 100 -- 5.5.3 Discussion 105 -- 6 STRENGHS AND LIMITATIONS 107 -- 7 CONCLUSIONS AND PERSPECTIVES FOR THE FUTURE 110 -- RECOMMENDATIONS 116 -- APPENDICES 11