The future

The final phase of the OCAFP will be the publication of updated incidence, mortality, survival and treatment analyses involving cases registered between 2015–2019. Treatment data for patients diagnosed in 2019 will help demonstrate whether surgical treatment rates improved during the period in which the clinical community was involved in the OCAFP project and provide an insight into evolving changes in the geographical variation demonstrated in the Treatment Report. It is expected that the fuller impact of the pandemic on cancer diagnosis and treatment will be captured in the forthcoming national ovarian cancer audit, which will analyse cases diagnosed and further analysis of treatments administered during 2020 onwards.

In May 2021 the HQIP announced that it would be commissioning five new cancer audits for England and Wales, to be delivered through a National Cancer Audit Collaborating Centre. This includes ovarian cancer, meaning the OCAFP had achieved its goal of demonstrating the benefit of, and making the case for, a nationally funded ovarian cancer audit.

The provision of more granular data at provider level via CancerStats2 enabled individual providers to use it to explore and challenge practice within their geography, with teams who exhibited low surgery rates reviewing pathways to search for factors which can be addressed to improve access to surgery for an increased proportion of patients. Examples of local impact are provided in Appendix 2, which lists comments from consultants across England.

The demonstration of lower surgery rates for patients diagnosed in trusts which do not house a specialist gynaecological cancer centre has particularly focused attention on the management of women diagnosed in these hospitals through the emergency presentation pathway. A number of Cancer Centres have used data from the OCAFP reports to demonstrate need and access grant funding for service transformation research to optimise clinical pathways. Publication of updated data in the final OCAFP report and the forthcoming national ovarian cancer audit will support further and more detailed work on clinical pathways to optimise surgery and chemotherapy treatment rates.

Based on the outcomes of the OCAFP disease profile and treatment reports, the BGCS convened a multidisciplinary group to devise quality performance indicators (QPIs) that set minimum and optimum standards for cancer care providers. The OCAFP data was crucial in establishing real-world benchmarking standards which have been demonstrated to be achievable in highly performing Cancer Alliances. The QPIs¹ were agreed by the gynaecological cancer clinical community after a period of consultation with the BGCS membership, and represent the first data-driven, evidence-based QPIs for ovarian cancer in England.

In 2022, the Royal College of Obstetricians and Gynaecologists (RCOG) agreed that all cancer centres applying to accredit their hospitals for subspecialty training would need to demonstrate compliance with these QPIs as a condition for accreditation or reaccreditation. It is envisaged that the forthcoming national ovarian cancer audit will publish data against these QPIs.

¹ Sundar S, Nordin A, Morrison J, Wood N, Ghaem-Maghami S, Nieto J, Phillips A, Butler J, Burton K, Gornall R, Dobbs S, Glasspool R, Peevor R, Ledermann J, McNeish I, Ratnavelu N, Duncan T, Frost J, Lim K, Michael A, Brockbank E, Gajjar K, Taylor A, Bowen R, Andreou A, Ganesan R, Nicum S, Edmondson R, Clayton R, Balega J, Rolland P, Maxwell H, Fotopoulou C. British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer. Cancers (Basel). 2023 Jan 4;15(2):337.