One-year net survival for the 19 Cancer Alliances varied between 62.9% and 75.2%, 5-year net survival varied between 28.6% and 49.6%.
Figure 10. Net survival rates of patients with ovary, fallopian tube and primary peritoneal carcinomas excluding borderlines at one and 5 years by Cancer Alliance, 2013 to 2017 diagnoses (Source: CAS AV2017)
Variation in survival between regions may suggest possible variation in the quality of treatment (surgery and chemotherapy) between different gynaecological cancer centres. However, survival is also dependent on many other factors, including the profile of the population being treated and access to care. For example, there are differences in age, general health (including comorbidities), ethnicity and socioeconomic profiles of different regional populations across England, which could all impact on survival following a diagnosis of ovarian cancer. Additionally, there may be variation in the provision of primary care which would restrict access for patients in some areas to primary care services.
One-year survival is often considered to be an indicator of late presentation of malignancy, with poor one-year survival associated with diagnosis at late stage. In ovarian cancer, the patient’s ability to undergo treatment once diagnosed (measured by their WHO performance status score) is an important indicator of late diagnosis. If data completeness allows, performance status will be used in the planned output on short-term mortality. Five-year survival is more likely to reflect the quality of treatment administered by the gynaecological cancer MDTs, in addition to the other associated factors mentioned above.
One of the principal aims of the Ovarian Cancer Audit Feasibility Pilot is to explore these complex factors in order to understand variations in treatment approaches between Cancer Alliances. We will explore whether the survival variation seen in these charts can be fully explained by population factors, or whether there are examples of best practice in ovarian cancer management in some areas of the country which could be extended to other regions in order to improve outcomes for patients.