Experiences from the German quality assurance program QS OVAR in partially platinum-sensitive recurrent ovarian cancer

Abstract

Background The QS OVAR is a voluntary quality assurance program for German hospitals, which focuses the treatment quality in ovarian cancer (OC). This evaluation gives insight into common treatment patterns and efficacy of guideline-directed therapy of patients with partially platinum-sensitive (PPS) recurrent ovarian cancer (ROC). Methods The QS OVAR 2004 and 2008 included patients with histologically-proven invasive epithelial OC diagnosed in the third quarter of either 2004 or 2008. These patients were followed over 4 years. PPS was defined as diagnosis of ROC at 6-12 months after primary treatment. For analysis of quality of care and adherence to guidelines, as well as outcome in terms of survival, patients must have had received primary treatment and survived for >28 days after diagnosis of PPS to adjust for non-adherence in patients attending the centre who were already critically ill. Results A total of 1354 patients in the QS OVAR program received primary treatment and 443 (32.7%) of these had no recurrence until last follow-up. PPS recurrence was diagnosed in 233 (17.2%) patients. The vast majority of PPS patients had stage IIIC (151/64.8%) or IV (50/21.5%) disease at primary diagnosis, and only 35.3% (n=82) had a macroscopic complete resection at primary surgery. Twenty-four (10.3%) patients with PPS survived for <28 days. Of the 209 (89.7%) patients who survived >28 days, 32 (15.3%) received no chemotherapy, 102 (58.3%) received platinum-based chemotherapy (CTX) and 73 (41.7%) received a non-platinum-containing regimen. According to German guidelines, 114 (54.6%) patients received standard treatment consisting of platinum-based combination therapy or pegylated liposomal doxorubicin monotherapy, 63 (30.1%) received a non-standard treatment and 32 (15.3%) received no CTX. There was a significant improvement in median survival after standard treatment (23.3 months) versus non-standard treatment (15.3 months) and no CTX (6.2 months, p=0.004). Conclusions Nearly half of patients with PPS did not receive treatment according to the national guidelines. Adherence to guidelines is a quality indicator with significant impact on prognosis in PPS ROC.