Transcript Management of Vulval Cancer Services in South West England Jenny Weeks J Verne L Hirschowitz, V Udaysanker, AD Falconer on behalf SWCIS Gynaecology Tumour Panel September.

Management of
Vulval Cancer Services
in South West England
Jenny Weeks
J Verne L Hirschowitz, V Udaysanker, AD Falconer on behalf
SWCIS Gynaecology Tumour Panel
September 2004
SWIS Gynaecology
Tumour Panel
Multidisciplinary membership
4 Cancer Networks
3 Counties
ASWCS
Peninsula
Dorset
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Background
• Calman Hine Report 1995
• Improving Outcomes Guidance
Gynaecological Cancer 1999
• SWCIS Regional Standards & Guidelines
(Royal College Pathologists/ Obstetricians &
Gynaecologists)
-> improvement in care and outcomes ?
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UKCCR 2004
Aim of the Audit
• Monitor treatment against
standards
• Have outcomes improved?
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Standards
• Managed by gynaecologist with special
interest in oncology (Regional/IOG)
• Minimum dataset recorded (IOG) eg
• Histological Type
• Grade
• ASA
• Groin nodes taken if Stage >IA (Regional)
• Skin - clear margins from tumour ≥ 8mm
(Regional)
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Method
• All new diagnoses squamous carcinoma
of vulva (1997 to 2002)
• Data collected by gynaecology
specialist nurses, gynaecologists,
oncologists & audit departments
• Supplementary data from SWCIS
information systems
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Results
• 1997 – 2002: 435 cases squamous cell
carcinoma (18 verrucous subtype)
• Surgery 80% radiotherapy 9%
• Stage I 33%
Stage II 28%
Stage III 16%
Stage IV 6%
not stated 16%
35%
30%
25%
20%
15%
10%
5%
0%
I
II
III
IV
not stated
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Age & Stage at diagnosis
160
patient
140
120
Stage I
100
Stage II
80
Stage III
60
Stage IV
40
not stated
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0
20s
30s
40s
50s
60s
70s
80s
90s
Decade
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% Surgery by ‘gynaecologist with
oncology interests’
100%
operations
80%
60%
40%
20%
0%
1997
1998
1999
2000
2001
2002
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% Recorded (Min Data Set)
• Cohort
ASA
Stage
Grade
97 - 98
90%
87%
91%
99 – 00
77%
80%
88%
01 - 02
78%
83%
92%
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Width Tumour-free margins
60%
operations
50%
40%
Ops/Cons
≥8mm
≤8mm
30%
not stated
20%
10%
0%
97- 98
99 - 00
01 - 02
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% operations ≥ 8mm margin by
Consultant ‘activity level’
70%
60%
50%
Ops/Cons
<5
40%
5 to 9
30%
≥ 10
20%
10%
0%
97- 98
99 - 00
01 - 02
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Nodes Taken (≥ Stage IB)
70%
60%
Nodes
taken
Ops/Cons yes
patients
50%
40%
no
30%
nk
20%
10%
0%
97- 98
99 - 00
01 - 02
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1997 to 2000
0.50
0.75
1.00
Kaplan-Meier survival estimates, by age category
0.00
0.25
Ops/Cons
0
1
Years since treatment
<70years
>80 years
2
3
>70 and <80years
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1997 to 2000
0.50
0.75
1.00
Survivor functions, by stage adjusted for age
0.00
0.25
Ops/Cons
0
1
2
3
Years since treatment
Stage I
Stage III
not stated
Stage II
Stage IV
15
1997 to 2000
0.75
0.50
0.25
0.00
•
1.00
Survivor functions, by Treatment Year
adjusted for age
0
1
Years since treatment
1997
1999
2
3
1998
2000
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Conclusion
• Centralisation of surgery has
occurred
• Improvements in practice - not yet
• Improvements in outcome
– too soon to say?
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Thank you
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