Survival

The following are net survival rates for 2015 to 2019 diagnoses in England of ovary, fallopian tube and primary peritoneal carcinomas (C56-C57, C48 excluding sarcomas), excluding all borderline tumours and all tumours coded to D39.1 in ICD-10. See Appendix 1 for a full cohort definition. All rates are net rates, age standardised with International Cancer Survival Standard (ICSS) weights. Net survival rates compare the survival of cancer patients with that of the general population. See Appendix 4 for more information on the survival methodology applied.

Survival data by ICB, Cancer Alliance, NHS Region and for all of England are available in Table 5 and Table 6 of the data downloads section.

For ovary, fallopian tube and primary peritoneal carcinomas, excluding borderlines in all of England, the one-year net survival rate was 68.4%, and the five-year net survival rate was 35.1%.

Figure 9. Net survival rates of patients with ovary, fallopian tube and primary peritoneal carcinomas excluding borderlines at one and 5 years, England, 2013 to 2017 diagnoses (Source: CAS AV2017)

One-year net survival for the 21 Cancer Alliances varied between 60.9% and 75.8%, five-year net survival varied between 27.8% and 47.5%.

Figure 10. Net survival rates of patients with ovary, fallopian tube and primary peritoneal carcinomas excluding borderlines at one and five years by Cancer Alliance, 2015 to 2019 diagnoses (Source: CAS AV2020)

Variation in survival between regions may suggest possible variation in the quality of treatment (surgery and chemotherapy) between different gynaecological cancer centres. However, survival is also dependent on many other factors, including the profile of the population being treated and access to care. For example, there are differences in age, general health (including comorbidities), ethnicity and socioeconomic profiles of different regional populations across England, which could all impact on survival following a diagnosis of ovarian cancer. Additionally, there may be variation in the provision of primary care which would impact on referral into secondary care for diagnosis and treatment.

One-year survival is often considered to be an indicator of late presentation of malignancy, with poor one-year survival associated with diagnosis at late stage. Five-year survival is more likely to reflect the quality of treatment administered by the gynaecological cancer MDTs, in addition to the other associated factors mentioned above.

One of the principal aims of the Ovarian Cancer Audit Feasibility Pilot is to explore these complex factors in order to understand variations in treatment approaches between Cancer Alliances. We go on to explore whether the survival variation seen in these charts can be fully explained by population factors, or whether there are examples of best practice in ovarian cancer management in some areas of the country which could be extended to other regions in order to improve outcomes for patients.

One-year net survival for ovary, fallopian tube and primary peritoneal carcinomas excluding borderline tumours has increased from 57.6% for 2001 to 2005 diagnoses to 68.4% for 2015 to 2019 diagnoses. Five-year net survival estimates have also improved, from 25.9% for patients diagnosed in 2001 to 2005 up to 35.1% for patients diagnosed in 2015 to 2019.

Figure 11. Net survival rates of patients with ovary, fallopian tube and primary peritoneal carcinomas including and excluding borderlines at one and five years, 2001 to 2019 diagnoses (Source: CAS AV2020)

The steady improvement in both one and five-year survival rates likely represents improvements in various aspects of care in England since the turn of the century. Between 2000 and 2005 specialist gynaecological oncology centres with specialist MDTs were established throughout the country, providing access to centralised specialist surgery for all women regardless of where they live.

The major barrier to one-year survival remains access to timely diagnosis. Cancer registration data analyses such as the OCAFP publications and the Get Data Out programme indicate that patients diagnosed at stage 4 have lower survival rates and lower treatment rates than those diagnosed with earlier stage disease. This suggests that a proportion of women may be presenting too unwell from advanced disease to enable the specialist teams to administer effective chemotherapy or surgery. The improvement in one-year survival suggests that we may be starting to impact on this issue, likely due to increased awareness of symptoms amongst women and primary care practitioners, and improved diagnostic and early treatment pathways in secondary care.

The improvement in five-year survival likely reflects not only improving access to treatment, but also increased treatment effectiveness. There are likely to have been real improvements in the quality of surgery available to women following the publication of the NHS Cancer Plan in 2000, with the establishment of specialist gynaecological cancer centres throughout England. Ovarian cancer surgery is now performed throughout the country by subspecialist accredited gynaecological oncology surgeons with specialist cancer surgery training. Surgical radicality for ovarian malignancies has generally increased during the past two decades, and there have been several improvements in chemotherapy treatments for newly diagnosed and recurrent disease. Over recent years women have had access to new maintenance treatments which help to prevent disease recurrence, and the impact of these treatments will be increasingly seen in five-year survival data during the coming years. The precise contributions of each of the factors described above are unknown, but they have all likely had an impact in the improvement of five-year survival, and further improvements in diagnostic pathways, surgical and medical treatments will hopefully continue the upward trend in one- and five-year survival rates in the future.