Aims
Australia’s Cancer Council has produced Optimal Care Pathways (OCP) to guide the delivery of collaborative, equitable and evidence-based cancer care. This study aims to assess adherence to OCP guidelines with respect to the time from multidisciplinary meeting (MDM) to commencement of radiation (RT) and/or systemic therapy (ST) and investigate any factors associated with delayed start.
Methods
A clinical audit was undertaken of patients treated through the Mid North and North Coast Cancer Institutes with care plans for gynaecological cancers (ICD10 codes 51-56) from 2013-2023. Dates for MDM and start of RT and/or ST were identified. The time elapsed was compared to OCPs to assess adherence; for vulvovaginal cancers which lacks an Australian OCP, the NHS 60day best practice pathway was used.
Results
310 cases were analysed. Across all cancer types, 41.46% of patients met the guidelines for start of systemic therapy compared to 42.36% of radiotherapy patients. Despite these proportions being similar, the mean wait time to commence RT was 11.952 days longer than that for ST (95% CI 2.651-21.253, p=0.012). For ST, cervical, uterine and ovarian cancer patients were more likely to meet guidelines than vulvovaginal (OR 2.19, 8.3 and 4.19 respectively). Compared to patients with vulvovaginal cancers, cervical and uterine cancer patients were 3.26 and 16.99 times, respectively, more likely to meet OCP guidelines for start of RT. This study finds that patient age and distance from cancer institute were not associated with delayed care.
Conclusions
The adherence to these OCP guidelines can be improved for all gynaecological malignancies. Vulvovaginal cancer patients are least likely to meet their respective guidelines and will benefit from a specific Australian OCP. Factors contributing the longer wait times from MDM to RT and poor adherence to vulvovaginal care guidelines should be explored, with the aim of enhancing equitable and evidence-based care.