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TEMPLATE DESIGN © Overview: Management Of Ovarian Cancer in Primary Care (1)Fabian Lee, Foundation Year 2. (2) Gbolahan Somoye, Senior Registrar. (3) Sherif Saleh, Consultant Gynaecologist. Gynaecology Department, Aberdeen Royal Infirmary, NHS Grampian, Scotland, UK. Introduction and Objectives Ovarian cancer is the leading cause of gynaecology cancer deaths in the UK with a 5-year survival rate of less than 35%; often presenting late with vague non-specific symptoms. A high index of suspicion in primary care may lead to the instigation of appropriate investigations and prompt referrals to secondary care. This study aims to provide an overview of the recognition and initial management of suspected ovarian cancer in primary care by: 1.Examining the quality of urgent referrals for suspected ovarian cancer to a specialist gynae- oncology service in Aberdeen, NHS Grampian (Scotland), UK; 2.Comparing and evaluating any change in practice of CA-125 testing and ultrasound (USS) investigations before (B) and after (A) the introduction of the NICE 122 guideline (April 2011). Methods 96 urgent referral letters from primary care for suspected ovarian malignancies received between October September 2011 were reviewed. Quality of referral letters before (B) and after (A) the introduction of the new NICE 122 guideline were examined. Clinical information provided along with relevant investigations requested in primary care before referral to secondary care were collated, looking specifically at: - Documentation of positive and negative physical examination findings (ascites and/or pelvic/abdominal mass – not obviously uterine fibroids) - Duration of symptoms - Specific symptoms (any one or more of the following; abdominal bloating, early satiety, abdominal or pelvic pain, urinary symptoms, or age >50 with symptoms of IBS) - General symptoms (any one or more of unexplained weight loss, fatigue, altered bowel habit, in which ovarian cancer is suspected) - Initial investigations (CA-125 & USS). Chi-square analysis was used to evaluate for change in practice of CA-125 testing and ultrasound (USS) investigations by comparing before (B) and after (A) percentages. GP referrals – Clinical information provided: 1.Documented abdominal examination = 68.8%. (B69% A68.5%) 2.PV examination performed = 27.1%. (B19.0% A33.3%) Results 3.Duration of symptoms in referrals = 56.3%.(B57.1% A55.6%) 4.Enquiry of specific symptoms = 74.0% (B71.4% A75.9%) 5.Enquiry of general symptoms = 50.0% (B47.6% A51.9%) 6.No details of any specific and/or general symptoms = 17.7% (B16.7% A18.5%) Initial investigations done in primary care: 1.Serum CA-125 requested = 80.2% (B71.4% A87.0%) 2.USS requested = 72.9% (B78.6% A68.5%) 3.Both CA-125 and USS requested = 60.4% (B59.5% A61.1%) 4.No CA-125 and/or USS = 7.3% (B9.5% A5.6%) Comparison of initial investigations before and after the introduction of the new NICE guidelines suggest no change in practice (p- value >0.01). Conclusions References Referral letters from primary to secondary care lack important clinical information. The study suggests that initial investigations of suspected ovarian cancer in primary care can be optimized further. Greater vigilance and instigation of investigations in primary care in accordance to the NICE 122 guideline will ensure prompt, good quality and correct referrals which may lead to early diagnosis and treatment thus improving outcome associated with late presentations. OPTIONAL LOGO HERE NICE Clinical Guideline 122 – Ovarian Cancer: The Recognition And Initial Management Of Ovarian Cancer.
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