title: Is Ovarian Cancer Being Managed According to Clinical Guidelines? Evidence From a Population-Based Clinical Audit.
abstract: In the northwestern Italian region of Piedmont, current statistics on hospitalizations show that surgical treatment for ovarian cancer (OC) is taking place in many small hospitals, as opposed to a more centralized approach. A population-based clinical audit was promoted to investigate whether OC is being managed according to clinical guidelines, identify determinants of lack of adherence to guidelines, and evaluate the association between adherence to guidelines and survival.
  
  
  
  Residents diagnosed with OC in 2009 were identified in the regional hospital discharge records database. All hospitalizations within 2 years from diagnosis were reviewed. Patients were classified according to their initial pattern of care, defined as "with curative intent" (CIPC) if including debulking surgery aimed at maximal cytoreduction. Adherence to guidelines for surgery and chemotherapy and the effects of this adherence on OC survival were investigated with logistic regression and Cox models.
  
  
  
  The final study sample consisted of 344 patients with OC, 215 (62.5%) of whom received CIPC. Increasing age, comorbidities, and metastases were negatively associated with receiving CIPC. In the CIPC group, surgical treatment was adherent to guidelines in 35.2%, whereas chemotherapy was adherent in 87.8%. Surgical treatment that was adherent to guidelines [hazard ratio (HR), 0.72; 95% confidence interval (CI), 0.45-1.15] and absence of residual tumor (HR, 0.55; 95% CI, 0.32-0.94) were associated with better survival in the CIPC group, and chemotherapy that was adherent to guidelines was associated with a significant reduction in the risk of death (HR, 0.49; 95% CI, 0.28-0.87).
  
  
  
  Results support the need to reorganize the clinical pathway of patients with OC in the Piedmont Region and the need for better adherence to current guidelines.
authors: Surgical Sciences Department, University of Turin, Torino, Italy.
authors: Simona
authors: S
authors: Sobrero
authors: Eva
authors: E
authors: Pagano
authors: Elisa
authors: E
authors: Piovano
authors: Lorenzo
authors: L
authors: Bono
authors: Manuela
authors: M
authors: Ceccarelli
authors: Anna
authors: A
authors: Ferrero
authors: Chiara
authors: C
authors: Macchi
authors: Marinella
authors: M
authors: Mistrangelo
authors: Silvia
authors: S
authors: Patriarca
authors: Elisa
authors: E
authors: Tripodi
authors: Roberto
authors: R
authors: Zanetti
authors: Oscar
authors: O
authors: Bertetto
authors: Giovannino
authors: G
authors: Ciccone
authors: Paolo
authors: P
authors: Zola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000401:mortality / Q000628:therapy*