CHAPTER 11 - Gynaecological oncology

Summary

Key points

1. ✓ The development of a national model of specialist teams and cancer networks has created high-quality equitable services across the country.

2. ✓ Multidisciplinary team care is the core of cancer treatment.

3. ✓ Patient-centred, evidence-based care is the central ethos of the service.

4. ✓ The national cancer peer-review process provides an effective means of quality assurance to drive up standards and will evolve from assessment of process to that of outcomes, as effective tools for outcome measurement are established.

5. ✓ Cancer waiting-time targets of 31 days from diagnosis to treatment and 62 days from referral to treatment have improved patient access.

6. ✓ The role of the clinical nurse specialist is critical to support patients through the entire cancer journey.

7. ✓ There is now adequate capacity for subspecialist training and accreditation, which are essential for the maintenance of a quality surgical oncology service and leadership of gynaecological oncology multidisciplinary teams.

8. ✓ Audit is a necessary means of identifying deficiencies and improving quality.

9. ✓ Research, particularly clinical trials, is critical to strengthening the evidence base and improving care.

Introduction

During the 1970s and 1980s, gynaecological surgeons with a special interest in oncology surgery established a number of services throughout Britain, mainly in university teaching hospitals. However, coverage of specialist gynaecological cancer care was patchy. Most women diagnosed with cervical, uterine, ovarian, vulval or vaginal cancer continued to be managed within small district general hospitals or teaching hospitals by generalist obstetricians and gynaecologists. As recently as the 1990s, the delivery of cancer care in general in the UK fell short of public expectation and was recognised as substandard. Survival rates were poor compared with those of the rest of Europe and the quality of care remained variable, with some highly specialised centres providing excellent care and others displaying a lack of specialised expertise. This persisting ‘postcode lottery’ became a national scandal.

The Government highlighted cancer services as an area of health care requiring modernisation, organisation and investment. An Expert Advisory Group to the Chief Medical Officers in England and Wales produced what was to become a seminal report on the direction of development of cancer services. The Calman Hine Report, A Policy Framework for Commissioning Cancer Services, was published in 1995 and laid out a national framework for the delivery of a properly organised and coordinated national cancer service. It directed future development of services with a ‘patient-centred’ focus, aiming for equitable high-quality care across the country.