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Management of Vulval Cancer Services in South West England

Management of Vulval Cancer Services in South West England. Jenny Weeks J Verne L Hirschowitz, V Udaysanker, AD Falconer on behalf SWCIS Gynaecology Tumour Panel. September 2004. SWIS Gynaecology Tumour Panel. 4 Cancer Networks. Multidisciplinary membership. 3 Counties. ASWCS.

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Management of Vulval Cancer Services in South West England

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  1. Management of Vulval Cancer Services in South West England Jenny Weeks J Verne L Hirschowitz, V Udaysanker, AD Falconer on behalf SWCIS Gynaecology Tumour Panel September 2004

  2. SWIS Gynaecology Tumour Panel 4 Cancer Networks Multidisciplinary membership 3 Counties ASWCS Peninsula Dorset

  3. Background • Calman Hine Report 1995 • Improving Outcomes Guidance Gynaecological Cancer 1999 • SWCIS Regional Standards & Guidelines (Royal College Pathologists/ Obstetricians & Gynaecologists) -> improvement in care and outcomes ?

  4. UKCCR 2004 Aim of the Audit • Monitor treatment against standards • Have outcomes improved?

  5. Standards • Managed by gynaecologist with special interest in oncology (Regional/IOG) • Minimum dataset recorded (IOG) eg • Histological Type • Grade • ASA • Groin nodes taken if Stage >IA (Regional) • Skin - clear margins from tumour ≥ 8mm (Regional)

  6. Method • All new diagnoses squamous carcinoma of vulva (1997 to 2002) • Data collected by gynaecology specialist nurses, gynaecologists, oncologists & audit departments • Supplementary data from SWCIS information systems

  7. Results • 1997 – 2002: 435 cases squamous cell carcinoma (18 verrucous subtype) • Surgery 80% radiotherapy 9% • Stage I 33% Stage II 28% Stage III 16% Stage IV 6% not stated 16%

  8. Age & Stage at diagnosis

  9. % Surgery by ‘gynaecologist with oncology interests’

  10. % Recorded (Min Data Set)

  11. Width Tumour-free margins Ops/Cons

  12. % operations ≥8mm margin by Consultant ‘activity level’ Ops/Cons

  13. Nodes Taken (≥Stage IB) Ops/Cons

  14. 1997 to 2000Kaplan-Meier survival estimates, by age category 1.00 0.75 0.50 Ops/Cons 0.25 0.00 0 1 2 3 Years since treatment <70years >70 and <80years >80 years

  15. 1997 to 2000Survivor functions, by stage adjusted for age 1.00 0.75 Ops/Cons 0.50 0.25 0.00 0 1 2 3 Years since treatment Stage I Stage II Stage III Stage IV not stated

  16. 1997 to 2000Survivor functions, by Treatment Year adjusted for age 1.00 0.75 0.50 0.25 0.00 0 1 2 3 Years since treatment 1998 1997 1999 2000

  17. Conclusion • Centralisation of surgeryhas occurred • Improvements in practice - not yet • Improvements in outcome – too soon to say?

  18. Thank you

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