title: Differences in regional diagnostic strategies and in intended versus actual first-line treatment of patients with advanced ovarian cancer in Denmark.
abstract: BACKGROUND
  Triage of patients with ovarian cancer to primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) is challenging. In Denmark, the use of NACT has increased, but substantial differences in the use of NACT or PDS exist among centers. We aimed to characterize the differences between intended and actual first-line treatments in addition to the differences in the triage process among the centers and to evaluate the different diagnostic modalities and the clinical aspects' influence in the triage process.
  
  
  METHODS
  From 4 centers, forms containing data about the diagnostic process and intended treatment were prospectively collected and merged with data from the Danish Gynecological Cancer Database and medical records.
  
  
  RESULTS
  Of the 671 completed forms, 540 patients had stage IIIC or IV epithelial ovarian cancer. Of the 238 (44%) referred to PDS, 91% received PDS and 4% never had debulking surgery. Of the 288 patients (53%) referred to NACT, 44% were never debulked. Fourteen patients (3%) were referred to palliative treatment. The use of different imaging modalities, diagnostic laparoscopy, and laparotomy varied significantly among the centers. Diagnostic surgical procedures were considered to be most influential in the triage process. Regardless of the intended first-line treatment or center, the tumor size and dissemination was the most influential clinical aspect.
  
  
  CONCLUSIONS
  In Denmark, substantial differences exist between intended and actual first-line treatments as well as in the diagnostic process and use of NACT, calling for further discussion on diagnostic strategy and therapeutically approach for patients with advanced ovarian cancer.
authors.affiliation: *Department of Gynecology, †Section of Surgical Pathophysiology; ‡The Finsen Laboratory and Biotech Research and Innovation Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen; §Department of Gynecology and Obstetrics, Odense University Hospital, Odense; ∥Department of Gynecology and Obstetrics, Herlev Hospital, Copenhagen University Hospital, Copenhagen; and ¶Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Carsten Lindberg
authors.initials: CL
authors.lastname: Fagö-Olsen
authors.forename: Bent
authors.initials: B
authors.lastname: Ottesen
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Sofie Leisby
authors.initials: SL
authors.lastname: Antonsen
authors.forename: Ib Jarle
authors.initials: IJ
authors.lastname: Christensen
authors.forename: Algirdas
authors.initials: A
authors.lastname: Markauskas
authors.forename: Berit Jul
authors.initials: BJ
authors.lastname: Mosgaard
authors.forename: Christian
authors.initials: C
authors.lastname: Ottosen
authors.forename: Charlotte Hasselholt
authors.initials: CH
authors.lastname: Sogaard
authors.forename: Claus
authors.initials: C
authors.lastname: Hoegdall
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077216:Carcinoma, Ovarian Epithelial; D003718:Denmark / Q000453:epidemiology; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006801:Humans; D033182:Intention; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods / Q000706:statistics & numerical data*; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014218:Triage / Q000379:methods
chemical_list: D000970:Antineoplastic Agents