Management of ovarian cancer in Scotland : policies for cancer care in the 1990s
Survival rates for patients with cancer vary enormously. It is generally accepted that variations in the biological activity of individual tumours contribute to survival differences but the influence of type of treatment and the organisation and delivery of such treatment is less well understood. The case records of all patients diagnosed with ovarian cancer in Scotland in 1987 were studied in depth looking for the factors which influenced survival outcome. Patient age, stage of disease, pathological type of tumour, histological differentiation and the presence of ascites all significantly influenced survival independently of each other. After adjustment for these five parameters it was found that the chance of dying was decreased if 1) the patient was seen initially by a gynaecologist, 2) the laparotomy was performed by a gynaecologist, 3) the tumour was maximally debulked, 4) the patient was managed by a multidisciplinary team in a combined clinic of specialists and 5) platinum chemotherapy was prescribed. In addition patients aged more than 65 years had poorer survival than those aged less than 65 years even after adjustment for the other four biological parameters. This older group of patients had maximum debulking surgery performed less frequently, were less often referred for specialist management and fewer received platinum chemotherapy. A geographical variation in outcome existed with the chance of dying from ovarian cancer being greatest in Health Board areas where the ratio of female population to consultant gynaecologist was much higher than average. Affluent patients had improved survival and were more likely to be seen initially by a gynaecologist, be referred for further specialist management and receive platinum chemotherapy.