MANAGEMENT OF OVARIAN-CANCER - REFERRAL TO A MULTIDISCIPLINARY TEAM MATTERS

Differences in survival outcome for patients with ovarian cancer in Sc otland led to an investigation of whether these differences were due t o variation in presenting prognostic features or to the organisation a nd delivery of cancer services. A retrospective study of all 533 cases of ovarian cancer registered in Scotland in 1987 was carried out. Aft er adjustment for age, stage, pathology, degree of differentiation and presence of ascites, survival improved when patients (1) were first s een by a gynaecologist (P<0.05); (2) were operated on by a gynaecologi st (P<0.05); (3) had residual disease of less than 2 cm post-operative ly (P<0.001); (4) were prescribed platinum chemotherapy (P<0.05); and (5) were referred to a joint clinic (P<0.001). When gynaecologists ope rated the likelihood of smaller residual disease increased (P<0.001). The improved survival from management by a multidisciplinary team at a joint clinic was not solely due to the prescription of platinum chemo therapy. The results of this study support the contents of the 1991 De partment of Health report on present acceptable practice in the manage ment of ovarian cancer, circulated to gynaecologists and surgeons in S cotland in 1992. The new finding that in a common cancer management by a multidisciplinary team at a joint clinic directly affects survival requires urgent attention.