Page 2 - Ovarian Cancer Surgery - Quality Indicators-Summary

Ovarian cancer is the leading cause of death among all gynecologic cancers and remains the most common cause
of death for 15 years after diagnosis in women with stage III-IV tumours. Surgery is the cornerstone in treatment of
advanced ovarian cancer. Quality of surgical care as a component of a comprehensive regimen of multidisciplinary
management has been shown to benefit the patient in other types of malignancies. Implementation of a quality
management program could impact survival of patients with advanced ovarian cancer2,3.

The European Society of Gynaecological Oncology (ESGO) has developed a list of quality indicators for
advanced ovarian cancer surgery that can be used to audit and improve the clinical practice in an easy
and practical way. After a comprehenseive literature search, each retained quality indicator was categorized
as structural indicator, process indicator, and outcome indicator.

A four-step evaluation process was followed:

Nomination of multidisciplinary international
development group

Identification of potential QIs (N = 15)

Identification of scientific evidence

Evaluation#1 International experts independently evaluate the relevance
and feasibility of each QI

Evaluation#2 International experts panel discussion of each potential QI 1st meeting
(10 quality indicators were retained)

Synthesis of scientific evidence

Evaluation#3 External panel of physicians and patients (international
reviewers) evaluates the relevance and feasibility of retained QIs

Evaluation#4 International experts panel discussion and integration 2nd meeting
of external panel comments 3th meeting

Final decision on definition of QIs, specifications,
targets, and scoring system

1 Ferlay, J. et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012.
Eur J Cancer 49, 1374-1403 (2013).
2 Harter, P. et al. Impact of a structured quality management program on surgical outcome in primary advanced
ovarian cancer. Gynecol Oncol 121, 615-619 (2011).
3 Aletti, G.D. et al. Quality improvement in the surgical approach to advanced ovarian cancer : the Mayo Clinic
experience. J Am Coll Surg 208, 614-620 (2009).
4 Mainz, J. Defining and classifying clinical indicators for quality improvement. Int J Qual Health Care 15,
523-530 (2003).

2 • ADVANCED (STAGE III-IV) OVARIAN CANCER SURGERY - QUALITY INDICATORS •