Advanced Ovarian Cancer Pathway (AOCP) Resources

The following section highlights the positive outcomes, achievements, and impact of the AOCP project, underscoring its successful implementation. However, it is equally important to acknowledge the key challenges encountered during the project. By listing these challenges, healthcare professionals reading this document can be informed and better equipped to mitigate them when considering the replication of similar quality improvement projects.

The Advanced Ovarian Cancer Pathway (AOCP) project was a critical initiative undertaken by Dr Dominic Blake and Mr Stuart Rundle from the Northern Gynaecological Oncology Centre in the UK. The core objective of this project was to streamline the patient journey, minimise healthcare inequalities, and optimise the survival rates for advanced ovarian cancer patients. The project's focus was on the Northeast and North Cumbria region, known for its higher-than-average upfront surgery rate without a correlating survival advantage for the population.

To tackle these issues, the project implemented several key measures, including the establishment of a dedicated Multidisciplinary Team (MDT) involving experts in gynaecological oncology, radiology, pathology, medical oncology, clinical nurse specialist teams, and anaesthetics. This team was designed to facilitate optimal treatment decisions and data collection, enabling faster decision-making processes and prompt execution of interval surgeries.

In addition, the project introduced pre-treatment optimisation via dietary interventions and physiotherapy, known as a prehabilitation service. This measure was to maintain patients' physical conditions before treatment, an important factor considering the strain that cancer treatments often put on patients' bodies. Implementation, however, faced hurdles such as staff shortages and a lack of a sustainable dietetic pathway. Nevertheless, the project continued with funding from the Northern Cancer Alliance for a pilot study.

Furthermore, to reduce the financial burden on patients and improve access to clinical trials, AOCP developed a unique "single point of decision" clinic, aiming to establish a streamlined process for the treatment of advanced ovarian cancer patients. This clinic allowed prompt histological diagnosis and offered a treatment decision on the same day, considerably reducing the time from assessment to diagnosis and treatment.

Data collection and analysis played a vital role in the project. Measures were implemented to comprehend survival outcomes for advanced ovarian cancer patients. These included MDT discussions, diagnostic biopsies, access to a dietician, anaesthetic assessments, and the collection of cancer target data. To support this, a dedicated data manager was assigned to facilitate data collection and analysis for continuous improvement.

Despite its significant achievements, the project faced several challenges. These included re-arranging working patterns within the teams, adjusting clinic templates for new patient clinics, evaluating radiological staging investigations, and overcoming communication difficulties as patients moved between different departments on the same day. Furthermore, the project did not decrease the rate of open/close laparotomy, nor the time to treatment interval. Additionally, an unexpectedly high number of patients underwent neoadjuvant chemotherapy, and the influence of post-pandemic systemic stresses on treatment decisions is still under investigation.

Nevertheless, the AOCP project has been instrumental in transforming advanced ovarian cancer patient care in the region. The creation of an efficient, robust standard operating procedure, enhanced patient engagement in pathway development, and the establishment of a beneficial prehabilitation program are just a few of the project's significant successes. It also ensured equal access to prehabilitation resources for all women preparing for radical treatment, an important step in addressing healthcare inequalities.

Looking towards the future, the project team has learned several valuable lessons, such as the need for earlier involvement of a wider clinical team, more regular meetings and data reviews, and balanced imaging discussions. Improvements on the horizon include assigning a dedicated project manager, fostering wider team participation, enhancing team communication, improving the imaging review process, and developing a reliable patient tracking system. The high rate of patients undergoing neoadjuvant chemotherapy will also be investigated to better optimise treatment decisions.

In conclusion, the AOCP project represents a significant stride forward in the treatment and care of advanced ovarian cancer patients. It underscores the necessity for continuous improvement, adaptability, and data-driven decision making in the rapidly evolving landscape of healthcare. It has set a benchmark for future healthcare projects, demonstrating the impact that thoughtful, patient-centred pathways can have on patient outcomes and experiences.