Enhancing Advanced Ovarian Cancer Care Delivery

September is Ovarian Cancer and Gynecologic Cancer Awareness Month. In the United States, ovarian cancer ranks as the fifth-leading cause of cancer-related deaths among women. Generally, cancer affects people of any age, race, ethnicity, and sex. Ovarian cancer, however, affects women age 70 years and older of various races (i.e., White, Black, Hispanic). For 2022, estimates show an expected 19,880 new cases and 12,810 ovarian cancer-related deaths.

When identified and treated at an early stage, the

five-year survival rate

for patients with ovarian cancer is approximately 49 percent. Unfortunately, most ovarian cancers are not identified until an advanced stage, when they are more difficult to treat. Survival rate at five years for advanced (distant) ovarian cancer is

29 percent

. Multiple factors make early diagnosis of ovarian cancer a challenge, including a lack of symptoms in early stages and symptoms that are not specific to a cancer diagnosis. Additionally, there is currently no reliable screening test for ovarian cancer.

In 2019, ACCC partnered with three cancer centers (The Blavatnik Family Chelsea Medical Center at Mount Sinai, Duke Cancer Center, and Willis-Knighton Cancer Center) to examine existing barriers to treating patients with advanced epithelial ovarian cancer and identify solutions to optimize the diagnosis and treatment of patients with the disease. This Phase I project was titled Barriers to Quality Care in Ovarian Cancer.

Through a series of

quality improvement (QI) workshops

, ACCC gathered participants’ data regarding their interest areas for a QI project. Two programs chose to focus on genetic counseling and testing, and one program focused on clinical trial enrollment and availability. Both topics are of great concern in the cancer community. Genetic testing for BRCA and HRD (homologous recombination deficiency) variants can assist in treatment planning specific to the patient’s needs (and genetics) and

is recommended

for every patient with ovarian cancer.

The first phase ended with some

key takeaways

:

• Top priorities for QI included genetic testing and counseling, clinical trial enrollment, and coordinated care across the multidisciplinary care team.
• A focused and structured QI approach, where consensus is built around a problem and solution, can address a specific quality issue in a relatively short time.
• Multiple stakeholders can contribute to QI solutions with a team approach and clear communication around quality gaps.

Next steps

ACCC and its partner organizations are implementing a new phase (Phase II) of work that will test the model developed by the partners in the first phase to optimize care for patients with advanced epithelial ovarian cancer. In Phase II, ACCC will conduct three QI workshops to implement the quality-of-care recommendations developed in the project’s first phase. ACCC will then study and measure the impact of the implemented recommendations at additional selected cancer programs and practices.

Phase II quality improvement workshops will focus on achieving the following objectives:

• Validate ideal care quality recommendations developed for patients with advanced ovarian cancer through process improvement workshops and outcomes measurements.
• Test the effectiveness of process improvement plans designed to optimize care delivery and outcomes for patients diagnosed with advanced ovarian cancer.
• Implement quality benchmarks over a six-month period to measure and assess progress.

This subsequent initiative will address care coordination and communication within the multidisciplinary cancer care team by implementing practice improvement plans that address identified barriers and challenges. As ACCC cancer programs and practices implement aspects of the quality recommendations developed through this initiative, we urge all to read them and identify how they can be applied at your institution upon their release.

For any questions or more information,

contact Doreen Effange, ACCC program manager

The Barriers to Quality Care in Ovarian Cancer education initiative is made possible by support from AstraZeneca and Merck.