title: Improvements in survival of gynaecological cancer in the Anglia region of England: are these an effect of centralisation of care and use of multidisciplinary management?
abstract: OBJECTIVE
  Our hypothesis is that the adoption of Department of Health (DH) guidance has led to an improvement in outcome in gynaecological cancer survival.
  
  
  METHODS
  In 1999 the DH in England introduced the Improving Outcomes in Gynaecological Cancer guidance, advising case management by multidisciplinary teams with surgical concentration in specialist hospitals. This guidance was rapidly adopted in the East of England, with a population of 2.5 million.
  
  
  METHODS
  The population of the Anglia Cancer Network was approximately 2.3 million.
  
  
  METHODS
  From 1996 to 2003, details of 3406 cases of gynaecological cancer were identified in the Anglia region of England. Survival analysis was performed by Cox proportional hazards regression, relative to cases diagnosed in 1996.
  
  
  METHODS
  Primary endpoint was survival.
  
  
  RESULTS
  The survival rates for cases diagnosed between 1996 and 1999 were broadly the same across the time period, with a marked improvement taking place in 2000, and continuing to 2003 (HR 0.71, 95% CI 0.64-0.79, comparing 2000-03 with 1996-99 diagnoses), for all gynaecological sites combined. Adjustment for treatments or method of case follow-up did not attenuate these improvements. There was a concurrent change towards major surgery being performed in specialist centres from 2000.
  
  
  CONCLUSIONS
  The adoption of the 1999 guidance on gynaecological cancer, which included multidisciplinary case management and centralisation of surgery, resulted in a marked step-change improvement in survival of gynaecological cancer in an area of eastern England in 2000.
authors.affiliation: Addenbrookes Hospital, Cambridge, UK. robin.crawford@addenbrookes.nhs.uk
authors.forename: R
authors.initials: R
authors.lastname: Crawford
authors.forename: D
authors.initials: D
authors.lastname: Greenberg
mesh_terms: D004739:England / Q000453:epidemiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000401:mortality* / Q000628:therapy; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D010348:Patient Care Team; D012041:Regional Medical Programs / Q000458:organization & administration*; D015996:Survival Rate