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  • Measure Summary
  • NQMC:011041
  • Jan 2016

Ovarian cancer: proportion of patients with early stage epithelial ovarian cancer (FIGO stage 1) undergoing primary surgery who have an adequate staging operation involving total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy and washings.

NHS Scotland, Scottish Cancer Taskforce. Ovarian cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 29 p. [11 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of patients with early stage epithelial ovarian cancer (International Federation of Gynecologists and Obstetricians [FIGO] stage 1) undergoing primary surgery who have an adequate staging operation involving total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy and washings.

This Cancer Quality Performance Indicator (QPI) measure is separated into two parts. Please refer to the related NQMC measure summary, Ovarian cancer: proportion of patients with early stage epithelial ovarian cancer (FIGO stage 1) undergoing primary surgery and operated on by a gynaecological oncologist, who have an adequate staging operation involving total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy and washings.

Note from the National Quality Measures Clearinghouse: This measure is part of the Cancer Quality Performance Indicators (QPIs) collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

Stage of disease is an important prognostic factor influencing choice of therapy and quality of surgical staging is a key determinant of adjuvant chemotherapy (Elit et al., 2004).

Surgery is considered the initial treatment of choice for women with early stage epithelial ovarian cancer and will typically include total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO) and omentectomy, and may also involve assessment by palpation, visualisation and/or biopsy as indicated, of peritoneal surfaces, appendix and bowel mesentery and sampling of pelvic and para-aortic lymph nodes (Australian Cancer Network & National Breast Cancer Centre, 2004).

Patients suspected of having ovarian cancer should be operated on by a gynaecological oncologist (Comprehensive Cancer Centre the Netherlands, 2011); this has been shown to improve survival for women with ovarian cancer. Some women do present with symptoms requiring surgery but with no specific clinical features to indicate cancer and are therefore operated on/managed by a general gynaecologist; the cancer diagnosis is only made based on post-operative histopathological assessment.

Evidence for Rationale

Australian Cancer Network, National Breast Cancer Centre. Clinical practice guidelines for the management of women with epithelial ovarian cancer. New South Wales (Australia): National Breast Cancer Centre; 2004 Mar 18. 205 p.

Comprehensive Cancer Centre the Netherlands. Ovarian carcinoma. [internet]. Amsterdam (The Netherlands): Association of Comprehensive Cancer Centres (ACCC); 2011 [accessed 2013 Aug 05].

Elit L, Fyles A, Chambers A, Fung-Kee-Fung M, Covens A, Carey M. Adjuvant care for stage I ovarian cancer. Toronto (ON): Cancer Care Ontario (CCO); 2004. 33 p. (Practice guideline report; no. 4-13). 

NHS Scotland, Scottish Cancer Taskforce. Ovarian cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 29 p. [11 references]

Primary Health Components

Epithelial ovarian cancer; primary surgery; total abdominal hysterectomy (TAH); bilateral salpingo-oophorectomy (BSO); omentectomy; washings

Denominator Description

All early stage (International Federation of Gynecologists and Obstetricians [FIGO] stage 1) epithelial ovarian cancer patients undergoing primary surgery (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of early stage (International Federation of Gynecologists and Obstetricians [FIGO] stage 1) epithelial ovarian cancer patients having primary surgery involving total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy and washings (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by the Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Public reporting

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All early stage (International Federation of Gynecologists and Obstetricians [FIGO] stage 1) epithelial ovarian cancer patients undergoing primary surgery

Exclusions

  • Patients having fertility conserving surgery
  • Patients with risk of malignancy index less than 200
  • Patients presenting for emergency surgery

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of early stage (International Federation of Gynecologists and Obstetricians [FIGO] stage 1) epithelial ovarian cancer patients having primary surgery involving total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy and washings

Exclusions

  • Patients having fertility conserving surgery
  • Patients with risk of malignancy index less than 200
  • Patients presenting for emergency surgery

Numerator Search Strategy

Institutionalization

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 95%

The tolerance allows for the small number of patients who have undergone previous surgery (hysterectomy or unilateral oophorectomy).

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce. Ovarian cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 29 p. [11 references]

Original Title

QPI 4 (i) – patients with early stage disease have an adequate staging operation.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Ovarian Cancer

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Ovarian Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jan

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

2017 Aug

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce. Ovarian cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 29 p. [11 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on April 25, 2017. The information was verified by the measure developer on May 23, 2017.

Copyright Statement

No copyright restrictions apply.

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