Quality Matters: Linking Patterns of Care to Ovarian Cancer Survival in a National Gynae-Oncology Registry

Ovarian cancer (OC) is a leading cause of gynecologic cancer mortality, with poor survival rates for advanced-stage disease. Comprehensive national data detailing contemporary patterns of care remain scarce. This study uses data from Australia's National Gynae-Oncology Registry (NGOR) to delineate current patterns of care against clinical quality indicators (CQIs) and correlate adherence to these measures with overall survival (OS).

This prospective study analyzed NGOR data for women with newly diagnosed epithelial OC across 47 sites between April 2017 and March 2024. Adherence to 15 predefined CQIs was assessed. OS, adjusted for key prognostic factors (Eastern Cooperative Oncology Group, age, stage, comorbidity), was estimated using Cox proportional hazards regression.

A total of 3,133 patients were included. In an adjusted multivariate analysis, significantly improved OS was associated with receiving first-line platinum-taxane doublet chemotherapy (hazard ratio [HR], 0.57 [95% CI, 0.47 to 0.68], P < .001), undergoing germline or somatic BRCA1/2 testing (HR, 0.66 [95% CI, 0.56 to 0.78], P < .001), and achieving no macroscopic residual disease after primary (HR, 0.48 [95% CI, 0.34 to 0.68], P < .001) or interval debulking surgery (HR, 0.56 [95% CI, 0.44 to 0.71], P < .001). Adjusted 5-year OS rates for International Federation of Gynecology and Obstetrics stages I, II, III, and IV were 87%, 76%, 42%, and 28%, respectively.

This national registry reveals variations in CQI adherence. While survival for advanced-stage disease has improved, it remains suboptimal. Adherence to specific quality indicators-notably optimal surgical cytoreduction, standard first-line chemotherapy, and genetic testing-is significantly associated with improved survival. Continuous monitoring and targeted quality improvement initiatives are essential for enhancing survival for women with OC.