One-stop clinic for patients with suspected ovarian cancer: results from a retrospective outcome study of the referral pathway.

BACKGROUND: Women with abdominal pain and bloating frequently have their Ca-125 levels investigated for suspected ovarian cancer and this has led to a significant increase in referrals to the ovarian cancer service. We have conducted this study to help improve the efficiency in which these patients are investigated and to improve future pathways within the referral service. METHODS: This was a retrospective observational outcome study. Data were collected from electronic documents of patients' referrals, assessments, and clinical correspondences over 48 months. The study was conducted in a secondary gynaecology cancer centre with direct referrals from primary care. The pelvic mass clinic was set up to include a consultation and an ultrasound scan with support available for patients if required. All patients included were referred directly from primary care for suspected ovarian cancer with Ca-125 result over a period of 2 years. RESULTS: 286 were referred from primary care according to the NICE guidelines of '2-week wait for ovarian cancer'. Only 223 patients who had a Ca-125 result reported at the time of their referral were included in the analysis. Out of the 223 patients, 126 patients were discharged with or without a repeat Ca-125 after the initial assessment. 18 patients were diagnosed with cancer following the referral, but only 12 of them had a primary ovarian malignancy. The malignancy rate in women under 50 years of age was 22% (4/18) and 78% (14/18) in women aged 50 or above. CONCLUSION: One-stop focused gynaecology ultrasound clinics where clinicians may assess patients and perform ultrasound scans for suspected cancer, may be better for managing this patient population due to improved efficiencies in waiting times, same day diagnosis and a reduction in waiting times to first appointment. Secondly, the majority of the patients with Ca-125 of more than 35 U/mL, who were referred through this pathway, did not have cancer. This review queries the future value of using Ca-125 as the basis for referrals from primary care for suspected ovarian malignancy. Further studies are required to assess whether a higher Ca-125 cut off may be used as the basis of referrals for premenopausal women.

Seeing is believing: patients' attitudes and information preferences towards robotic gynaecological surgery.

OBJECTIVES: Robotic gynaecological surgery (RS) is reported to be associated with feelings of apprehension and anxiety pre-operatively in a proportion of patients. This study aimed to investigate patients' understanding and perceptions towards RS, and whether format of RS information resources could improve acceptability of RS. DESIGN: A two-phase, sequential, mixed methods study involving semi-structured interviews of patients who had previously undergone gynaecological RS and a block-randomised crossover study of women from the general public. Qualitative data from interviews were analysed using thematic analysis, quantitative data from questionnaires were summarised and analysed using Mann-Whitney U and Fisher's exact tests. RESULTS: Interview participants reported very little background knowledge of RS prior to their surgery. Many participants stated that written information leaflets did not adequately describe the robotic set-up and procedure, leading to anxiety and information seeking from alternative sources. The use of videos or models to visually demonstrate how the surgery would be performed and the interaction between the surgeon and the robot were proposed to address patients' needs. Questionnaire data from 30 women demonstrated an increase in acceptability of RS following provision of information, with 73.3% of the participants reporting that the video alone was an adequate source of information, compared to only 46.7% for the printed leaflet. CONCLUSION: This study gives new insights into the impact of information provision for patients undergoing RS. Availability of information resources in different modality formats, in particular an information video, may help address patients' information needs, reduce anxiety and hence increase acceptability of RS.

Regular follow-up with cervical cytology is of questionable value following surgical treatment of microinvasive cervical cancer.

OBJECTIVES: To assess the follow-up smears and their outcomes of patients with conservatively managed early-stage cervical cancer as per UK guidelines within our service. To evaluate whether intensive follow-up can detect pre-cancer early compared to the standard 3 yearly follow-up. STUDY DESIGN: Retrospective review. METHODS: All patients treated for early stage (stage 1A1 and 1A2) with cervical cancer from 01/2002 to 01/2020 at University Hospitals of Derby and Burton were included. Patients who had initial hysterectomy were excluded from our analysis. Review conducted using electronic patient records for treatment, histology, and follow-up smears. Number of abnormal follow-up smears and number of recurrent cervical cancers were considered the main outcome measures. RESULTS: 98 cases were identified. 81 (82.65 %) were stage 1A1 and 17 (17.35 %) were stage 1A2. 74 (75.51 %) patients had squamous histology and 24 (24.49 %) had adenocarcinomas. Median follow-up was 11.08 years (4043 days). 510 follow-up smears were performed, of which 33 (6.47 %) were abnormal. 5 of these abnormal smears showed low grade dyskaryosis (0.98 %) and 2 smears showed high grade dyskaryosis (0.39 %). The positive predictive value of follow-up smears to detect pre-cancerous changes was 5.71 %. There were no recurrent cancers detected. CONCLUSIONS: Microinvasive cervical cancer is effectively managed with conservative surgery. There were no recurrent cancers detected in our cohort during follow-up and there were only 2 high grade dyskaryoses detected (n = 2/510, 0.39 %). We therefore believe that reducing the intensity of follow up of these patients should be considered.