Standard Operating Procedures (SOP)

Scottish Ovarian Cancer Forum (Pilot QI project)

The Scottish Ovarian Cancer Forum is a project involving a multi-centre collaborative real-time review of women with advanced ovarian cancer (Stages 3 and 4) who are being considered for upfront or interval surgery.

The NHS boards participating in this project are NHS Grampian, NHS Lothian, NHS Tayside and NHS Highland.

Objectives

The aims of the project are as follows:

• To streamline and standardise the patient pathway.
• To ensure good clinical governance and robust decision-making
• To increase surgical rates in line with QPI targets and improve patient survival.

Meeting Arrangements

The meeting will be held weekly via MS Teams on a Wednesday from 8am to 9am commencing on 22 June until the end of the project (February 2023).

Meeting Chair

The Meeting Chairs are Dr. Mary Cairns and Dr. Nidal Ghaoui Dit Ebef. The Chair will lead the meeting, allowing appropriate discussion for all patients and ensuring that all members have an opportunity to contribute.

Attendees

In attendance at these weekly meetings will be clinical representation from Radiologists, Gynae-Oncology Surgeons, Oncologists, Colorectal and HPB Surgeons, and Clinical Nurse Specialists. There will be attendance from each board participating as well as administrative support for each area.

A distribution list has been created to ensure all communication regarding the project is shared. If there is to be any change to the distribution list please contact the Regional Cancer Pathways Co-ordinator (NHS Grampian).

Patient Selection

The criteria for patients to be discussed at the meeting are as follows:

• All women with Stage 3-4 Ovarian cancer: at the time of diagnosis
• All women with Stage 3-4 Ovarian Cancer : after 3 cycles of chemotherapy
• All women with Stage 3-4 Ovarian cancer: after 6 cycles of chemotherapy if not had surgery.

The women to be reviewed at the weekly meeting should be identified by the local administrative team with clinical consultant input on each board and these cases should be presented by the referring consultant or deputy where possible.

A referral form for cases to be discussed should be completed and sent to the administrative support :

• NHS Grampian: Aynslie McKeith, Regional Cancer Pathways Co-ordinator
• NHS Highland: Anne Edwards, Cancer Audit Co-ordinator
• NHS Tayside: Valerie McLean, Gynaelogical Cancer Data Manager
• NHS Lothian: TBC

This should then be sent with the required dataset (see below) to the Regional Cancer Pathways Co-ordinator for collation and onward distribution of a list to all participants prior to the weekly meeting (gram.ovarianMDT@nhs.scot). All referrals for discussion should be sent to the administrative support by midday on the Monday preceding the meeting. The list for discussion will be sent on Tuesday each week.

The information for each region should include the following dataset:

1) Age, performance status, comorbidities, drug history and relevant social history

2) BMI

3) Histology (must be available for any IDS cases)

4) CT (at diagnosis and subsequent)

5) Chemotherapy data and recent CA125

Outcomes

A standard outcome form will be completed by the administrative support within each board and should contain all information that is required for the project database. The outcome form should be sent to the Regional Cancer Pathways Co-ordinator (NHS Grampian) for recording on the project spreadsheet.

The information required is noted below:

1. Stage at presentation (radiological)
2. Age, PS
3. Histology
4. Decision made: for upfront surgery/ neoadjuvant chemotherapy
5. Decision made: for IDS/not for IDS/consider IDS after 6 cycles:
6. Stratified:

• Surgery possible but patient factors preclude
• Surgery possible but patient declined
• Surgery not possible due to disease factors

1. Patient factors: age, co-morbidities, patient declined surgery,
2. Disease factors: Progression on chemotherapy, Stage 4B after 3/6 cycles, advanced low-grade cancers, patient died on chemotherapy.
3. Treatment actually carried out: surgical: no naked eye disease, disease <1cm, suboptimal debulking (disease>1cm)
4. Chemotherapy: drugs/cycles

Additional Information

Holiday Cover

Each region will arrange suitable cover for their administrative support during times of annual leave. This is to be clarified but Elsa Armstrong (NHS Grampian), Data Manager – Gynaecology will provide cover for the Regional Cancer Pathway Co-ordinator.

Key Dates:

• 15 June 2022 – Mock Meeting
• 22 June 2022 – 1st Meeting
• Project ends January 2023
• Report to be completed February 2023
• 7 March 2023 – end of project event