Intended for healthcare professionals


Ovarian cancer should be treated by specialist teams

BMJ 1999; 319 doi: (Published 10 July 1999) Cite this as: BMJ 1999;319:77
  1. Jacqui Wise
  1. London

    Women with ovarian cancer should be seen by expert teams based in cancer centres, and if surgery is needed it should by carried out by specialist gynaecological oncologists, according to guidance issued this week by the NHS Executive.

    The guidelines, which will be sent to all commissioners of cancer services in England and Wales, state that dedicated diagnostic and assessment services should be established in cancer units, to which all women with suspected gynaecological cancers should be referred. There should be specialist multiprofessional gynaecological oncology teams based in these centres, which would be responsible for the management of all women with ovarian cancer and most other gynaecological cancers.

    The guidelines follow a systematic review of the evidence carried out by the NHS Centre for Reviews and Dissemination at the University of York and published in Effective Health Care (1999; No 5). The review concluded that women with ovarian cancer live longer if they are treated by expert teams and if surgery is carried out by specialist gynaecological oncologists. This is not currently routine practice.

    Dr Arabella Melville, research fellow at the Centre for Reviews and Dissemination, said: “Outcomes in gynaecological cancer are poorer than they should be. There needs to be a restructuring of services so women are seen by teams with appropriate levels of expertise.

    A recent prospective study in Scotland showed that among women with stage III ovarian cancer, survival was longest among those whose surgery was performed by gynaecological oncologists rather than other surgeons. At three years after surgery the death rate for oncologists was 25% lower than for gynaecologists, and the death rate for general surgeons was 33% higher than for gynaecologists.

    The new guidelines have been developed by the National Cancer Guidance Steering Group. Professor Bob Howard, chairman of the steering group, said that substantial progress had already been made in managing the more common cancers. He added: It is tricky for the less frequently occurring cancers, and so this latest guidance will fill a major gap.”

    Effective Health Care is available at Improving Outcomes in Gynaecological Cancers: Guidance for Commissioners of Cancer Services may be obtained from the NHS Response Line (tel: 0541 555455); a summary for GPs is also available.

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