Background

The Ovarian Cancer Audit Feasibility Pilot (OCAFP) was a three-year collaboration between the gynaecological oncology clinical community, the charity sector and the NHS, conducted over the period from 2019 to 2023. During this time, a range of outputs on ovarian cancer have been reported. These can be found on the OCAFP project webpage.

The primary objective of the OCAFP was to explore whether it would be possible to undertake meaningful analyses of routinely collected data for the purpose of improving treatment and outcomes for women diagnosed with ovarian cancer in England – the leading cause of gynaecological cancer death for women in England. Visit the CancerData website to find out more.

In achieving this, the project aimed to make the case for an ongoing, publicly funded ovarian cancer audit. This goal was met when the Healthcare Quality Improvement Partnership (HQIP) announced a national ovarian cancer audit in 2022. The methodologies, successes, limitations, and associated intelligence from the OCAFP are now able to inform the development of the national ovarian cancer audit, which has the potential to build-on and extend the achievements of the OCAFP over the coming years.

The OCAFP was jointly funded by the British Gynaecological Cancer Society, Target Ovarian Cancer and Ovarian Cancer Action, and delivered by analysts within the National Disease Registration Service (NDRS). A Project Steering Group (PSG) met quarterly and oversaw the scope and direction of the pilot with input from senior representatives of each partner organisation. The day-to-day running of the pilot was managed by the Project Management Group (PMG), which comprised representatives of the four organisations and met monthly. We believe that this project has been a unique and highly significant achievement, demonstrating that the English clinical community and patient charities can come together with the support of NDRS to substantially improve the evidence required to improve patient care.

Over the course of the pilot, a programme of analytical projects was delivered that exclusively utilised existing data routinely collected during clinical practice and disease registration. Unadjusted and adjusted results were reported for each project, with regional variation in incidence, treatment, survival, and mortality all presented by Cancer Alliance. Where sufficient data were available, geographic variation was also reported by Clinical Commissioning Group (CCG), with granular unadjusted data made available to NHS employees at a provider level via the CancerStats2 website - (this opens in a new page). Please note that this platform requires an N3/HSCN secure network connection. 

This project summary report provides an overview of these projects, their impact on clinical practice and patient outcomes, and the limitations of the routine data sources that prohibited or limited some aspects of the project. The learning presented in this report is not only intended to support the development and scoping of the forthcoming national ovarian cancer audit, but also others seeking to utilise the national cancer data resources for the analysis of ovarian cancer, and those looking to utilise existing data items for other cancer sites and diseases. We believe that this is the first feasibility pilot of its type in England.

The first publication from the OCAFP was a Disease Profile Report, which describes ovarian cancer incidence, survival, and mortality across England. The second publication includes an analysis of surgery and chemotherapy rates across England, indicating variation in access to treatment between Cancer Alliances. The third report focuses on short-term mortality, describing variation in cases of death from ovarian cancer within 12 months of diagnosis. All three publications had a profound impact within the gynaecological cancer community, with evidence that the findings have been a lever for change and service improvement. Many Cancer Alliance gynaecology tumour site specific groups (TSSGs) and individual specialist gynaecological cancer specialist multidisciplinary teams (MDTs) have used the OCAFP data to benchmark their performance and outcomes against national and other regional data. These data comparisons have been used as a mechanism to highlight processes and pathways which can be improved to improve outcomes for future cohorts of ovarian cancer patients.

A fourth project was planned with the aim of assessing regional variation in the radicality of surgical practice. Regrettably data validation processes indicated insufficient surgical data quality to support publication of such a report. This summary document includes an overview of the planned methodology and the limitations identified. Learning from this exercise will inform changes and improvements to the routine capture of surgical data for ovarian cancers, hopefully enabling a future investigation into surgical practice and its variation across England.