Effect of Quality Control Program in Surgical Management of Early Cervical Cancer.
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ABSTRACT: Background
Regular assessments of clinical performance in gynecologic cancer surgery is important for the safety of patients. We evaluated the effects of quality control (QC) program on the treatment pattern and clinical outcomes of early cervical cancer.Methods
Medical records of cervical cancer patients who received operation in our institution from January 2007 to December 2018 were retrospectively reviewed. Cases were divided into 2 groups, before and after the initiation of QC program, group 1 (2007-2013) and group 2 (2014-2018), based on the operation date. Two groups were compared in clinicopathologic variables, surgical methods, operative details, adjuvant treatments, recurrence and survival.Results
A total of 305 cervical cancer patients were included in the analysis, 210 in group 1 and 95 in group 2. In group 2, minimally invasive surgery (MIS) was more frequently performed (60.0% vs. 76.8%, P = 0.004), especially in earlier stages (stage IA, 72.6% vs. 100.0%; stage IB, 52.2% vs. 69.5%). However, the median tumor size treated by MIS was decreased in stage IB (20 mm vs. 17 mm, P = 0.015). Frequency of adjuvant treatment was also reduced in stage IB (56.5% vs. 37.3%, P = 0.016). Recurrence within 3 years, 3-year disease free survival and overall survival did not show significant difference; however, 3-year recurrence after MIS was significantly reduced in stage IB.Conclusion
QC program enforced stricter patient selection criteria for MIS and positively affected clinical outcomes in cervical cancer patients who underwent surgery. Systemic monitoring should be considered for patient safety.
SUBMITTER: Shim JE
PROVIDER: S-EPMC8608925 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo determine whether process and outcome measures varied for patients with early-stage cervical cancer based on hospital surgical volume.MethodsUsing the National Cancer Database, we identified women with stages IA2 - IB1 cervical cancer (2011-2013). Annual hospital volume was calculated using number of hysterectomies performed in the prior year and grouped into patient level-quartiles. Centers in the highest quartile of volume were defined as HVCs; those in the lowest quartile, as LVCs. Demographics, type/mode of hysterectomy, lymph node assessment, NCCN-compliant surgery (radical hysterectomy (RH) with LND), and survival outcomes were compared across quartiles of hospital volume. Cox Proportional Hazards model was performed to determine impact of volume on mortality.ResultsWe identified 3469 women treated at 598 different hospitals. RH was more likely at HVCs versus LVCs (68.9% vs. 59.6%, p < 0.001). LND was more likely at HVCs versus LVCs (96.1% vs 87.3%, p < 0.001). Patients treated at HVCs were 11.4% more likely to receive guideline-compliant surgery compared to LVCs (67.8% vs. 56.4%, p < 0.001). There was no difference in 5-year survival, 90-day survival, all-cause mortality across volume quartiles. Thirty-day mortality was significantly lower at HVCs (0 deaths in 880 patients) versus LVCs (1 in 1058 (0.1%, p = 0.02)). Age ≥ 80, Medicaid and Medicare insurance, Hispanic race, and poorly differentiated histology were independent predictors of mortality. Hospital volume was not found to be an independent predictor of mortality (p = 0.95).ConclusionsHVCs demonstrated higher rates of NCCN-recommended surgery for early-stage cervical cancer. There was no association between hospital volume and survival.
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Project description:INTRODUCTION:Sexual activity is important for marital quality, especially in cervical cancer survivors. Vagina extension following laparoscopic radical hysterectomy with bilateral ovarian preservation (VEOP), vagina extension following laparoscopic radical hysterectomy with bilateral oophorectomy (VEBO), radical hysterectomy with bilateral ovarian preservation (RHOP), and radical hysterectomy with bilateral oophorectomy (RHBO) are the common surgeries for young cervical cancer patients. AIM:To investigate the effect of the 4 surgical methods on female/male sexual activity and marital quality in early-stage cervical cancer survivors. METHODS:Multiple linear regression analysis was conducted in 205 patients with stage Ia1-IIa2 cervical cancer to evaluate the factors that affected male/female sexual function and marital quality. MAIN OUTCOME MEASURE:Female Sexual Function Index (FSFI), modified Kupperman Index (KI), modified Sexual Life Quality Questionnaire (mSLQQ-QoL), and ENRICH marital inventory were used to reflect changes in female/male sexual function and marital quality in the 4 groups. RESULTS:Female/male sexual function and marital quality were both highest in the VEOP group and lowest in the RHBO group. The regression results showed that ovarian preservation and vaginal extension were associated with female/male sexual function and marital quality. Furthermore, when vaginal extension and ovarian preservation were replaced by vaginal length, sexual psychological change, and hormone level index (KI), respectively; male sexual function was associated with vaginal length and sexual psychological change, whereas female sexual function and marital quality were only associated with hormone level and sexual psychological change. Clinical statistics found that four-fifths of the recurrent patients had vaginal extension (P = .042), and 3-quarters of these patients had large tumors. CONCLUSION:Ovarian preservation and vaginal extension are both important for male/female sexual activity and marital quality. Vaginal extension may play a positive role in female sexual life via psychology and in male sexual life via vaginal length. Vaginal extension may not be suitable for patients with large masses. Zhang Y, Sun S, Ding J, et al. The Effect of Different Surgical Methods on Female and Male Sexual Activity and Marital Quality in Patients With Early-Stage Cervical Cancer. Sex Med 2020;8:307-314.
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Project description:Pooled human serum (Sentinel Serum Samples) was aliquoted for storage at -80C and subsequently had NMR spectra acquired annually for three years. This was to determine sentinel serum sample utility for a quality management program to monitor NMR reproducibility. Sentinel serum quality control samples allowed the quantification of variance between different profilers within a project. They also demonstrated declines in metabolite concentrations over time. A sentinel program is useful for tracking changes in QC serum samples from long-term storage. Separately, QC samples show negligible variance introduced by multiple profilers of NMR spectra within a project.
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Project description:BackgroundSurgical-pathological risk factors were evaluated by weighting the magnitude of significance of multiple risk factors correlating to survival and treatment response in cervical cancer.MethodsMultivariate analysis was performed for survival outcomes entering seven pathological factors obtained from 540 radical hysterectomy specimens in stage IA2-IIB cervical cancer cases. Hazard ratio (HR) in each risk factor was determined, and the sum of HR scores for the corresponding risk factors was determined per case. Survival curves and postoperative treatment response (concurrent chemoradiotherapy (CCRT) vs radiotherapy alone) were evaluated based on the extent of HR-weighted scores.ResultsHazard ratios for risk factors relating to disease-free survival (DFS) was: lympho-vascular space invasion 3.95, nodal metastasis 3.88, adenocarcinoma 3.40, large tumour 2.36, positive margin 1.99, deep stromal invasion 1.29, and parametria invasion 1.21. The HR-weighted scoring method showed a high predictive value for recurrence (area-under-curve 0.836, P<0.001). Hazard ratio-weighted scores were negatively correlated to DFS, and the cases with score ?12.5 showed 5-year DFS rate of 23.8%. Tumours with larger score offset the benefits of CCRT over radiotherapy alone for postoperative adjuvant treatment (P<0.001).ConclusionSurgical-pathological risk factors provide valuable information for survival and management of early-stage cervical cancer when number and significance of risks are weighted.
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Project description:PurposeTo estimate the cost-effectiveness of breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).MethodsUsing a modified CISNET breast cancer simulation model, we estimated outcomes for women aged 40-64 years associated with three scenarios: breast cancer screening within the NBCCEDP, screening in the absence of the NBCCEDP (no program), and no screening through any program. We report screening outcomes, cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and sensitivity analyses results.ResultsCompared with no program and no screening, the NBCCEDP lowers breast cancer mortality and improves QALYs, but raises health care costs. Base-case ICER for the program was $51,754/QALY versus no program and $50,223/QALY versus no screening. Probabilistic sensitivity analysis ICER for the program was $56,615/QALY [95% CI $24,069, $134,230/QALY] versus no program and $51,096/QALY gained [95% CI $26,423, $97,315/QALY] versus no screening.ConclusionsOn average, breast cancer screening in the NBCCEDP was cost-effective compared with no program or no screening.
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Project description:BackgroundThe National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast cancer screening to medically underserved, low-income women aged 40-64 years. No study has evaluated NBCCEDP's effect on breast cancer mortality.PurposeThis study estimates life-years saved by NBCCEDP breast cancer screening compared with screening in the absence of NBCCEDP and with no screening.MethodsA breast cancer simulation model based on existing Cancer Intervention and Surveillance Modeling Network models was constructed. The screening module from these models was modified to reflect screening frequency for NBCCEDP participants. Screening data for uninsured women represented what would have happened without the program. Separate simulations were performed for women who received NBCCEDP (Program) screening, women who potentially received screening without the program (No Program), and women who received no screening (No Screening). The impact of NBCCEDP was estimated as the difference in life-years between the Program and No Program, and the Program and No Screening scenarios. The analysis was performed in 2008-2009.ResultsAmong 1.8 million women who were screened between 1991 and 2006, the Program saved 100,800 life-years compared with No Program and 369,000 life-years compared with No Screening. Per woman screened, the Program saved 0.056 life-years (95% CI=0.031, 0.081) compared with No Program and 0.206 life-years (95% CI=0.177, 0.234) compared with No Screening. Per woman with invasive breast cancer and screen-detected invasive cancer, the Program saved 0.41 and 0.71 life-years, respectively, compared with No Program.ConclusionsThese estimates suggest that NBCCEDP breast cancer screening has reduced mortality among medically uninsured and underinsured low-income women.
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