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Surgeons at work

The National Institute for Clinical Excellence (NICE) has published new guidelines for the best surgery for some women who have advanced ovarian cancer. Maximal cytoreductive surgery is a major operation that aims to remove all visible disease when the cancer has been diagnosed late. Maximal cytoreductive surgery can include surgery on the bowel, spleen, breathing muscle and other organs in the body apart from surgery to remove the womb and ovaries.

Over the past 10 years, I have led research to find out whether maximal cytoreductive surgery is better for women than more limited surgery and with this week’s publication, I am pleased to see that the University of Birmingham’s findings will lead to more women having access to this surgery.

Why is this? Research conducted at our Institutes of Cancer & Genomic Sciences and Applied Health Research showed that in centres where this operation is routinely conducted, patients had six months increased overall survival rates compared to those that only conducted less extensive surgery.

Put differently, women with late-stage ovarian cancer treated at centres that routinely conduct maximal cytoreduction surgery have a 20% reduction in their chance of dying from ovarian cancer.

Professor Sudha Sundar - University of Birmingham

Put differently, women with late-stage ovarian cancer treated at centres that routinely conduct maximal cytoreduction surgery have a 20% reduction in their chance of dying from ovarian cancer.

Crucially, at 12 months after surgery, quality of life following the operation was no different between women who underwent extensive surgery compared to those who underwent less extensive procedures - which was contrary to what might have been expected.

That this new guidance has been published matters.

Ovarian cancer is the sixth most common cancer in females in the UK and it the most common gynaecological cancer after uterus. It carries a lifetime risk of about two percent in women in England and Wales. Most ovarian cancer cases are diagnosed at a late stage as early symptoms, such as bloating and abdominal pain can be confused with other conditions. It is also the most common cause of gynaecological cancer-related deaths.

Cancer Research UK have shared sobering statistics about the difference between how diagnosis speed affects survival rates. Diagnosed at its earliest stage, almost all (98%) people with ovarian cancer will survive their disease for one year or more, compared with more than 1 in 2 (54%) people when the disease is diagnosed at the latest stage.

Just over half (51%) of women with ovarian cancer in England will receive standard of care treatment which is a combination of surgery and chemotherapy. The new NICE guidance offers hope that more women can have surgery – something which is so important for the best possible survival from this cancer

Ovarian cancer is a huge burden affecting women across the UK and anything that improves survival rates and quality of life for women is significant. Increasing the time that women can spend with those they love after a late-stage diagnosis has a profoundly positive impact and is something that I am immensely proud to have contributed to.

The previous guidance for how ovarian cancer surgery was approached was based, falsely, on the assumption that maximal cytoreductive surgery would be a trade-off of better survival rates, but with a worse quality of life, that many women wouldn’t want. Thanks to our research, which has included listening to the patient-reported outcomes from women, we found that maximal cytoreductive surgery gave women better survival outcomes without harming quality of life

However, there is far more work to be done to improve ovarian cancer care before women should ever get to the place where they would need maximal surgery.

I am leading new research that is trialling a way to join up primary, secondary and specialist care – we hope to greatly improve the time it takes to diagnose and begin to treat ovarian cancer in society. The gap between survival rates is the difference between 1 in 50 and 1 in 2 women dying from ovarian cancer in the first year depending on when they are diagnosed.

We will be working with GPs in the Modality partnership and Sandwell & West Birmingham Hospitals NHS Trust, and the University of Birmingham will be evaluating whether a new way of diagnosing ovarian cancer will encourage more women to get tested, and access treatment quicker.

It has been nearly nine months since the Government first published their Women’s Health Strategy for England, and in that time, we have seen the gestation of research and health policy changes for women’s health that gives me hope. Guidance like NICE’s new publication should be an encouragement for more effort, more energy, and a greater voice for women in their health.

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