Improved outcomes due to changes in organization of care for patients with ovarian cancer in the Netherlands

• In the past decade patterns of care for ovarian cancer patients have changed.
• High volume hospitals achieve the best cytoreductive outcomes.
• The majority of Dutch ovarian cancer patients receive neo-adjuvant chemotherapy.
• Surgical outcomes and overall survival have improved within the past ten years.

ObjectivesObjectives of this study were to evaluate the effect of changes in patterns of care, for example centralization and treatment sequence, on surgical outcome and survival in patients with epithelial ovarian cancer (EOC).MethodsPatients diagnosed with FIGO stage IIB-IV EOC (2004–2013) were selected from the Netherlands Cancer Registry. Primary outcomes were surgical outcome (extent of macroscopic residual tumor after surgery) and overall survival. Changes in treatment sequence (primary debulking surgery and adjuvant chemotherapy (PDS + ACT) or neo-adjuvant chemotherapy and interval debulking surgery (NACT + IDS)), hospital type and annual hospital volume were also evaluated.ResultsPatient and tumor characteristics of 7987 patients were retrieved. Most patients were diagnosed with stage III-IV EOC. The average annual case-load per hospital increased from 8 to 28. More patients received an optimal cytoreduction (tumor residue ≤ 1 cm) in 2013 (87%) compared to 2004 (55%, p < 0.001). Complete cytoreduction (no macroscopic residual tumor), registered since 2010, increased from 42% to 52% (2010 and 2013, respectively, p < 0.001). Optimal/complete cytoreduction was achieved in 85% in high volume (≥ 20 cytoreductive surgeries annually), 80% in medium (10–19 surgeries) and 71% in small hospitals (< 10 surgeries, p < 0.001). Within a selection of patients with advanced stage disease that underwent surgery the proportion of patients undergoing NACT + IDS increased from 28% (2004) to 71% (2013). Between 2004 and 2013 a 3% annual reduction in risk of death was observed (HR 0.97, p < 0.001).ConclusionChanges in pattern of care for patients with EOC in the Netherlands have led to improvement in surgical outcome and survival.