Standards for the management of cervical and vulval carcinoma.
OBJECTIVE
To examine the feasibility of achieving designated target standards for the management of women with cervical and vulval cancer.


METHODS
Retrospective casenote review.


METHODS
The Gynaecological Oncology Centre at Hammersmith Hospital, London.


METHODS
Sixty-one women with cervical and vulval cancer presenting to the gynaecological oncology clinic at the Hammersmith Hospital during 1996 and 1997. Various aspects of the management of those women were compared with standards suggested by a multidisciplinary panel of local experts. Targets included the referral and treatment process, the accuracy of staging, and measures of surgical performance.


RESULTS
The target interval of seven days between receipt of the referral and the first visit at the cancer centre was achieved in 93% of women. Surgical treatment was administered to 92% of the women within the target of 20 working days from the first clinic appointment. Tumour close to or involving the margins of the specimen was noted in 13% of cervical and 9% of vulval cancers. The node count fell below the target standards in 13% of pelvic and 10% of groin dissections. Appropriate imaging investigations for staging were not undertaken in 15 of 39 cases (38%) of cervical cancer and in 5 out of 22 (23%) of vulval cancers.


CONCLUSIONS
The suggested targets of process and surgical performance are reasonable and achievable. These standards would be appropriate for national use. The area most clearly identified where these targets were not achieved was the requesting of complementary staging investigations. This could be addressed by the use of a simple investigation protocol to be included in each patient's notes and available at specialist clinics and gynaecology wards.
D'Arcy
T J
TJ
Institute of Obstetrics and Gynaecology, Hammersmith Hospital, London, UK.
Roy
A
A
Thomas
A
A
McIndoe
A
A
Soutter
W P
WP
D019985:Benchmarking; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy; D003695:Delivery of Health Care / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*; D014846:Vulvar Neoplasms / Q000473:pathology / Q000628:therapy*