QUALITY INDICATORS (QIs) IN RARE OVARIAN CANCER MANAGEMENT SUGGEST A REGIONAL-LEVEL ORGANISATION Introduction Rare ovarian tumours represent about 25% of all ovarian cancers. The uncommonness of these diseases and the great variability of age, histological subtypes and stages lead to multiple and compound therapeutic strategies. A project has been conducted - at Regional level within the Piedmont Region Cancer Care Network (PRCCN) providing a quality control of treatment for malignant epithelial ovarian cancer (clinical audit). As an add-on to this project, an exploratory study has been proposed to the PRCCN which likewise aims to describe patterns-of-care, assess the adherence to clinical guidelines, identify determinants of appropriateness of care of ovarian rare tumours. Materials and methods To this purpose, the centres participating to the oncology network were invited to collect retrospectively low incidence ovarian tumors. Investigated histotypes were identified through specific research strings in the pathological archives The following histotypes were used as inclusion criteria: a) sex cord-stromal tumours, germ-cell tumors ;b) small cell carcinomas, and rare epithelial cancers: mucinous, clear-cell, carcinosarcoma, adenosarcoma, malignant Brenner tumors and low-grade serous carcinomas. ; c) All non-serous, and serous borderline tumors with peritoneal implants and/or with micro papillary aspects. Quality indicators of diagnostic and therapeutic pathway have been proposed through a review of existing literature and documents (including EORTC-GCG process quality indicators for ovarian cancer, The French national network ovarian rare tumours website, www.ovaire-rare.org,). Results 474 Patients diagnosed with rare ovarian tumours were included retrospectively, over a 10 year period, (among 5 centres, pilot study). Adherence to guidelines for diagnosis, surgery and chemotherapy were reported together with QI indicators. The retrospective study allowed us to identify areas of weakness in the diagnostic and therapeutic pathway that could be the object of management optimization. Two items have been identified: 1) classification and 2) management setbacks. Finally the collection of rare tumors will be proposed to all the participating centers to the PRCCN with the rationale of a rare ovarian tumors registry able to identify the need for expert pathology review, patients’ files discussion in dedicated regional multidisciplinary tumor board and finally optimising appropriateness of care of ovarian rare tumours. Conclusion: it is expected that the management of rare cases with a regional-level organization will be of benefit not only for patients, but also for epidemiological, clinical and biological research.
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