Kerryn Lutchman-Singh, Nagindra Das, Christine Davies and Nicolette S Sirju
Swansea Bay University Health Board
Ovarian cancer is the major cause of death for women diagnosed with a gynaecological cancer in the UK. Wales has relatively worse survival rates and this appears to be due to delays in the diagnostic pathway for women with suspected early and advanced stages.
The single cancer pathway in Wales, sets out a recommended timeline for women to compete the diagnostic pathway (21 days), yet this was seldom achieved as primary care providers had too many diagnostic hurdles to navigate, leading to inevitable delays in diagnosis.
Our pilot project was designed to improve survival outcomes for women with ovarian cancer as per the National Optimal Pathway for Ovarian cancer in Wales:
- For patients with suspected early-stage ovarian cancer:
Diagnostic pathway < 28 days from point of Suspicion (PoS) and first definitive treatment < 62 days from PoS
- For patients with a suspected metastatic (advanced) ovarian cancer:
First definitive treatment < 21 days from PoS
The Ovarian one stop clinic offers the patient a same-day rapid diagnostic program.
Project Aims and Objectives:
Aim: To improve survival outcomes for women with ovarian cancer.
Objective 1: To reduce the time taken to diagnose ovarian cancer (early detection) and the time taken to optimise patients for treatment.
Objective 2: To improve on the recommended timelines as set out by the National Optimal Pathway for Ovarian cancer in Wales.
Objective 3: To provide appropriate specialist and CNS input at the first visit, enabling patient- centred care and expertise as early as possible in the management pathway.
Objective 4: To improve patient experience by giving an earlier definitive plan of management/reassurance if there is unlikely cancer.
Objective 5: To apply an enhanced version of current NICE guidance; by obtaining virtually all the required information for the MDT discussion on the same day while also providing patient-centred care.
Objective 6: To simplify diagnostic navigation for General Practitioners thus preventing inevitable delays in Ovarian cancer diagnosis.
This one-stop service reduces diagnostic waiting times for women with ovarian cancer and provides appropriate specialist and Clinical nurse specialist input at the first visit. This facilitates immediate patient-centred care in the management pathway.
The flow chart model describes the pathway process from primary care assessment to the patient’s first definitive treatment. This improved approach incorporates stakeholders in primary and secondary care, nursing, radiology, administration, finance and cancer performance directors.
To improve the clinical utility of the clinic, the referral criteria was disseminated to all GP practices within Swansea Bay. A new electronic grading option on WCP (titled ovarian one-stop) got GPs to refer directly.
A new service to facilitate early diagnosis of patients with suspected ovarian cancer was developed. Our outcomes show that patients entering this diagnostic pathway were given adequate care and support from the beginning, whilst facilitating a process to provide early diagnosis and management respectively.