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Bergin RJ, O'Sullivan D, Dixon-Suen S, Emery JD, English DR, Milne RL, White VM. Time to Diagnosis and Treatment for Ovarian Cancer and Associations with Outcomes: A Systematic Review. J Womens Health (Larchmt) 2024. [PMID: 38976232 DOI: 10.1089/jwh.2023.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background: Ovarian cancer is commonly diagnosed symptomatically at an advanced stage. Better survival for early disease suggests improving diagnostic pathways may increase survival. This study examines literature assessing diagnostic intervals and their association with clinical and psychological outcomes. Methods: Medline, EMBASE, and EmCare databases were searched for studies including quantitative measures of at least one interval, published between January 1, 2000 and August 9, 2022. Interval measures and associations (interval, outcomes, analytic strategy) were synthesized. Risk of bias of association studies was assessed using the Aarhus Checklist and ROBINS-E tool. Results: In total, 65 papers (20 association studies) were included and 26 unique intervals were identified. Interval estimates varied widely and were impacted by summary statistic used (mean or median) and group focused on. Of Aarhus-defined intervals, patient (symptom to presentation, n = 23; range [median]: 7-168 days) and diagnostic (presentation to diagnosis, n = 22; range [median]: 7-270 days) were most common. Nineteen association studies examined survival or stage outcomes with most, including five low risk-of-bias studies, finding no association. Conclusions: Studies reporting intervals for ovarian cancer diagnosis are limited by inconsistent definitions and reporting. Greater utilization of the Aarhus statement to define intervals and appropriate analytic methods is needed to strengthen findings from future studies.
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Affiliation(s)
- Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Deirdre O'Sullivan
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Suzanne Dixon-Suen
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- School of Exercise & Nutrition Sciences, Deakin University, Burwood, Australia
| | - Jon D Emery
- Department of General Practice and Primary Care, Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Victoria M White
- School of Psychology, Deakin University, Burwood, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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Bourgeois J, Peacock HM, Savoye I, De Gendt C, Leroy R, Silversmit G, Stordeur S, de Sutter P, Goffin F, Luyckx M, Orye G, Van Dam P, Van Gorp T, Verleye L. Quality of surgery and treatment and its association with hospital volume: A population-based study in more than 5000 Belgian ovarian cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107978. [PMID: 38306864 DOI: 10.1016/j.ejso.2024.107978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/05/2024] [Accepted: 01/20/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Different sets of quality indicators are used to identify areas for improvement in ovarian cancer care. This study reports transparently on how (surgical) indicators were measured and on the association between hospital volume and indicator results in Belgium, a country setting without any centralisation of ovarian cancer care. METHODS From the population-based Belgian Cancer Registry, patients with a borderline malignant or invasive epithelial ovarian tumour diagnosed between 2014 and 2018 were selected and linked to health insurance and vital status data (n = 5119). Thirteen quality indicators on diagnosis and treatment were assessed and the association with hospital volume was analysed using logistic regression adjusted for case-mix. RESULTS The national results for most quality indicators on diagnosis and systemic therapy were around the predefined target value. Other indicators showed results below the benchmark: genetic testing, completeness of staging surgery, lymphadenectomy with at least 20 pelvic/para-aortic lymph nodes removed, and timely start of chemotherapy after surgery (within 42 days). Ovarian cancer care in Belgium is dispersed over 100 hospitals. Lower volume hospitals showed poorer indicator results compared to higher volume hospitals for lymphadenectomy, staging, timely start of chemotherapy and genetic testing. In addition, surgery for advanced stage tumours was performed less often in lower volume hospitals. CONCLUSIONS The indicators that showed poorer results on a national level were also those with poorer results in lower-volume hospitals compared to higher-volume hospitals, consequently supporting centralisation. International benchmarking is hampered by different (surgical) definitions between countries and studies.
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Affiliation(s)
- Jolyce Bourgeois
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, Brussels, B-1000, Belgium.
| | - Hanna M Peacock
- Belgian Cancer Registry, Koningsstraat 215, Bus7, Brussels, B-1210, Belgium
| | - Isabelle Savoye
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, Brussels, B-1000, Belgium
| | - Cindy De Gendt
- Belgian Cancer Registry, Koningsstraat 215, Bus7, Brussels, B-1210, Belgium
| | - Roos Leroy
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, Brussels, B-1000, Belgium
| | - Geert Silversmit
- Belgian Cancer Registry, Koningsstraat 215, Bus7, Brussels, B-1210, Belgium
| | - Sabine Stordeur
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, Brussels, B-1000, Belgium
| | - Philippe de Sutter
- Department Gynaecology-Oncology, UZ Brussel - VUB, Brussels, B-1210, Belgium
| | - Frédéric Goffin
- Department of Obstetrics and Gynaecology, University Hospital of Liège, Liège, Belgium
| | - Mathieu Luyckx
- Service de Gynécologie et Andrologie and Institut Roi Albert II, Cliniques Universitaires Saint-Luc, UCLouvain, Brussel, Belgium
| | - Guy Orye
- Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium
| | - Peter Van Dam
- Division of Gynecological Oncology, Multidisciplinary Oncologic Centre, Antwerp University Hospital, Wilrijkstraat 10, Edegem, B-2650, Belgium; Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Universiteitsplein 1, Wilrijk, B-2610, Belgium
| | - Toon Van Gorp
- University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Leen Verleye
- Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, Brussels, B-1000, Belgium
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Pfisterer-Heise S, Scharfe J, Kugler CM, Shehu E, Wolf T, Mathes T, Pieper D. Protocol for the development of a core outcome set for studies on centralisation of healthcare services. BMJ Open 2023; 13:e068138. [PMID: 36944460 PMCID: PMC10032414 DOI: 10.1136/bmjopen-2022-068138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Centralisation defined as the reorganisation of healthcare services into fewer specialised units serving a higher volume of patients is a potential measure for healthcare reforms aiming at reducing costs while improving quality. Research on centralisation of healthcare services is thus essential to inform decision-makers. However, so far studies on centralisation report a variability of outcomes, often neglecting outcomes at the health system level. Therefore, this study aims at developing a core outcome set (COS) for studies on centralisation of hospital procedures, which is intended for use in observational as well as in experimental studies. METHODS AND ANALYSIS We propose a five-stage study design: (1) systematic review, (2) focus group, (3) interview studies, (4) online survey, (5) Delphi survey. The study will be conducted from March 2022 to November 2023. First, an initial list of outcomes will be identified through a systematic review on reported outcomes in studies on minimum volume regulations. We will search MEDLINE, EMBASE, CENTRAL, CINHAL, EconLIT, PDQ-Evidence for Informed Health Policymaking, Health Systems Evidence, Open Grey and also trial registries. This will be supplemented with relevant outcomes from published studies on centralisation of hospital procedures. Second, we will conduct a focus group with representatives of patient advocacy groups for which minimum volume regulations are currently in effect in Germany or are likely to come into effect to identify outcomes important to patients. Furthermore, two interview studies, one with representatives of the German medical societies and one with representatives of statutory health insurance funds, as well as an online survey with health services researchers will be conducted. In our analyses of the suggested outcomes, we will largely follow the categorisation scheme developed by the Cochrane EPOC group. Finally, a two-round online Delphi survey with all stakeholder groups using predefined score criteria for consensus will be employed to first prioritise outcomes and then agree on the final COS. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Committee at the Brandenburg Medical School Theodor Fontane (MHB). The final COS will be disseminated to all stakeholders involved and through peer-reviewed publications and conferences.
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Affiliation(s)
- Stefanie Pfisterer-Heise
- Institute for Health Services and Health System Research, Center for Health Services Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Julia Scharfe
- Institute for Health Services and Health System Research, Center for Health Services Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Charlotte Mareike Kugler
- Institute for Health Services and Health System Research, Center for Health Services Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Eni Shehu
- Institute for Health Services and Health System Research, Center for Health Services Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Tobias Wolf
- Institute for Health Services and Health System Research, Center for Health Services Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Tim Mathes
- Institute for Medical Statistics, University Medical Center Goettingen, Göttingen, Germany
| | - Dawid Pieper
- Institute for Health Services and Health System Research, Center for Health Services Research Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
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British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer. Cancers (Basel) 2023; 15:cancers15020337. [PMID: 36672287 PMCID: PMC9856668 DOI: 10.3390/cancers15020337] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 01/06/2023] Open
Abstract
Ovarian cancer survival in the UK lags behind comparable countries. Results from the ongoing National Ovarian Cancer Audit feasibility pilot (OCAFP) show that approximately 1 in 4 women with advanced ovarian cancer (Stage 2, 3, 4 and unstaged cancer) do not receive any anticancer treatment and only 51% in England receive international standard of care treatment, i.e., the combination of surgery and chemotherapy. The audit has also demonstrated wide variation in the percentage of women receiving anticancer treatment for advanced ovarian cancer, be it surgery or chemotherapy across the 19 geographical regions for organisation of cancer delivery (Cancer Alliances). Receipt of treatment also correlates with survival: 5 year Cancer survival varies from 28.6% to 49.6% across England. Here, we take a systems wide approach encompassing both diagnostic pathways and cancer treatment, derived from the whole cohort of women with ovarian cancer to set out recommendations and quality performance indicators (QPI). A multidisciplinary panel established by the British Gynaecological Cancer Society carefully identified QPI against criteria: metrics selected were those easily evaluable nationally using routinely available data and where there was a clear evidence base to support interventions. These QPI will be valuable to other taxpayer funded systems with national data collection mechanisms and are to our knowledge the only population level data derived standards in ovarian cancer. We also identify interventions for Best practice and Research recommendations.
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Baldewpersad Tewarie NMS, van Driel WJ, van Ham M, Wouters MW, Kruitwagen R. Clinical auditing as an instrument to improve care for patients with ovarian cancer: The Dutch Gynecological Oncology Audit (DGOA). Eur J Surg Oncol 2021; 47:1691-1697. [PMID: 33581966 DOI: 10.1016/j.ejso.2021.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The Dutch Gynecological Oncology Audit (DGOA) was initiated in 2014 to serve as a nationwide audit, which registers the four most prevalent gynecological malignancies. This study presents the first results of clinical auditing for ovarian cancer in the Netherlands. METHODS The Dutch Gynecological Oncology Audit is facilitated by the Dutch Institute of Clinical Auditing (DICA) and run by a scientific committee. Items are collected through a web-based registration based on a set of predefined quality indicators. Results of quality indicators are shown, and benchmarked information is given back to the user. Data verification was done in 2016. RESULTS Between January 01, 2014 and December 31, 2018, 6535 patients with ovarian cancer were registered. The case ascertainment was 98.3% in 2016. The number of patients with ovarian cancer who start therapy within 28 days decreased over time from 68.7% in 2014 to 62.7% in 2018 (p < 0.001). The percentage of patients with primary cytoreductive surgery decreased over time (57.8%-39.7%, P < 0.001). However, patients with complete primary cytoreductive surgery improved over time (53.5%-69.1%, P < 0.001). Other quality indicators did not significantly change over time. CONCLUSION The Dutch Gynecological Oncology Audit provides valuable data on the quality of care on patients with ovarian cancer in the Netherlands. Data show variation between hospitals with regard to pre-determined quality indicators. Results of 'best practices' will be shared with all participants of the clinical audit with the aim of improving quality of care nationwide.
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Affiliation(s)
- N M S Baldewpersad Tewarie
- Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands; Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands.
| | - W J van Driel
- Center of Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Department of Gynecology, Amsterdam, the Netherlands
| | - M van Ham
- Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - M W Wouters
- Dutch Institute for Clinical Auditing (DICA), Scientific Bureau, Leiden, the Netherlands; Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands
| | - R Kruitwagen
- Maastricht University Medical Centre (MUMC), Department of Obstetrics and Gynecology, and GROW- School for Oncology and Developmental Biology, Maastricht, the Netherlands
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Frawley T, Meehan A, De Brún A. Impact of organisational change for leaders in mental health. J Health Organ Manag 2018; 32:980-1001. [PMID: 30468417 DOI: 10.1108/jhom-08-2018-0220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services. DESIGN/METHODOLOGY/APPROACH Data were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard's framework. FINDINGS Three overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders' ability to focus on, and advance, the quality and safety agenda. RESEARCH LIMITATIONS/IMPLICATIONS Typical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged. PRACTICAL IMPLICATIONS There is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making. ORIGINALITY/VALUE The study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.
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Affiliation(s)
- Timmy Frawley
- School of Nursing, Midwifery and Health Systems, University College Dublin College of Health Sciences , Dublin, Ireland
| | - Annabel Meehan
- Mental Health Division, St John of God Community Mental Health Services, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin College of Health Sciences , Dublin, Ireland
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Abstract
This article begins by introducing the historical background surrounding the volume-outcomes relationship literature, particularly in complex cancer surgery. The state of evidence surrounding mortality, as well as other outcomes, in relation to both hospital and surgeon procedure volume is synthesized. Where it is understood, the level of adoption of regionalization of various complex surgeries in the United States is also presented. Various controversies are weighed and discussed. Finally, various models of regionalization and proposed alternatives to regionalization from the peer-reviewed literature are presented.
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Affiliation(s)
- Stephanie Lumpkin
- Department of Surgery, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Karyn Stitzenberg
- Department of Surgery, University of North Carolina, Chapel Hill, NC 27514, USA.
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