National Women's Annual Clinical Report 2010

This analysis includes the 353 inpatient surgeries performed by the Gynaecologic
Oncology team in 2010 where a diagnosis of cancer was confirmed. The complications
data were checked for accuracy against discharge coding data.
Summary/Implications
The Department of Gynaecologic Oncology workload has increased again in 2010, with
a rise in both MDM referral (707 new referrals) and surgical activity (353 inpatient
surgeries). The introduction of the MDM based database at the end of 2008 has allowed
complete capture of data for all referrals for presumed malignancy for 2010. These
figures however do not include all departmental activity as preinvasive referrals seen in
the vulval and colposcopy clinics are not included, nor are molar pregancies and genetic
referrals. This database has also allowed collection of complete surgical data, including
morbidity.
The department is still failing to meet the KPI standards set in 2007. The percentage of
patients discussed at MDM/seen in clinic within the 2 week standard has increased, but
is still failing to meet the targeted 90%. This delay is due to a combination of inadequate
referral information, thus requiring input from the department to chase the relevant
investigations, and adequate resources within the ADHB MDM group. It is hoped that
the proposed appointment of a formal MDM coordinator will streamline this process and
remove unnecessary administrative duties from clinic staff. Some lack of clinical
resources, however still needs to be addressed as most deferrals are due to pathological
review not done in a timely fashion. The role of the pathologist is crucial to the MDM and
appropriate FTE should be allocated to this.
The KPI targets do not capture all of the work within the department; molar pregnancy
consultations and follow up, and prophylactic surgery for genetic predisposition, account
for approximately 100 referrals a year and are not included in these data. Whether all
molar pregnancies need to be seen by a gynaecologic oncologist is currently being
reviewed, and it may be more appropriate for patients to be followed up locally.
Even though the KPI from MDM/clinic to surgery shows the targets are not being met in
40 cases, in 16 of those cases delays were either planned due to chemotherapy,
radiotherapy or fertility treatments or patients initially declined surgery and changed their
minds later. In 10 patients delay was due to needing to optimise patient condition before
surgery could be safely carried out. All patients are given a date for surgery in 2-3 weeks
at the time they are seen in the gynaecologic oncology clinic. It is always important to
endeavour to meet targets but it is more crucial to look into causes for “delay” to look for
avenues to improve. This is currently not captured in our data.
The complication rates within the department are acceptable. The transfusion rate at
11% on review is associated with an increase in radicality of surgery. The majority of
patients transfused were those undergoing extensive debulking surgery, often in
combination with significant bowel resection. However this means our debulking rates
are comparable with other units, with 75% of ovarian malignancies, being optimally
debulked and 68% with no residual disease.
The increase in theatre resources in 2010 has improved the patient’s wait for surgery.
This will also allow the department to increase the services offered. It is hoped that the
use of laparoscopic surgery for selected malignancies will increase, and that sentinel
nodes for early vulval cancer can be introduced. The department is committed to
providing a high quality regional tertiary service and the potential improvement in
resources should facilitate this.
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