Implementation of disease management guidelines in patients with advanced ovarian cancer

Individual variability in care practices traditionally has been a strong force in oncology practice in the United States. Such variability has necessarily led to inconsistencies in resource utilization and quality of care. The concept of outcomes management has grown from a recognition of this variability and from a desire to both optimize the quality of care and control costs. Disease management guidelines are based on the current best evidence and expert opinion. Designed to outline appropriate frameworks for care, guidelines reduce variability, minimize underutilization and overutilization of resources, provide compliance information, and ultimately lead to improved quality of care. Guidelines also can form a critical framework for cost estimation. The development of guidelines for salvage therapy of ovarian cancer at our institution has led to an excellent ability to estimate costs. Institution of these guidelines has led to several findings, including the realization that the use of more expensive drugs does not necessarily lead to an increase in the overall costs of care. The use of oral agents was found to be far less expensive than the use of intravenous agents, however. Efficacy analyses are ongoing. The goals for the management of advanced ovarian cancer in traditional care and managed care settings are the same: high-quality care with attention to costs. Such an approach can increase the number of patients with this challenging disease who have access to high-quality care.