Title: Optimising care diagnosis and treatment pathways to ensure cost effectiveness and best practice in gynaecological cancer: improving the evidence for the NHS
Funder: Department of Health (England)

Abstract: 6. Details of proposed programme Background (1000 characters max): (Note: Abbreviations are defined in Section 16)When the major gynaecological cancer sites are combined they have the second highest incidence of any female cancer in the UK (17083 cases in 2007 UKCR figures) behind breast cancer and ahead of colorectal and lung cancer. Mortality from gynaecological cancer in the UK (9537 deaths between 2007-2008 UKCR figures) is only lower than lung and breast cancer. The NHS has made major improvements in gynaecological cancer care and it is one of the most integrated and multidisciplinary areas in medicine with an active Improving Outcome Guidance (IOG) programme. This is important as there are seven tumour sites with multiple complex care pathways. This application extends and updates the current NIHR award which the Group received in 2007 and which is due to complete in March 2011. This scheme has proven to be hugely successful (see Appendix 1). We also intend to include a number of cancer topics covering aspects of cancer care not specific to gynaecological oncology as the Group is also responsible for publishing ‘orphan’ cancers. These are reviews of interventions that include many different types of cancer including neurological soft tissue sarcomas and aspects of care not relating to a specific cancer site.Theme and scope of proposed programme (1000 characters max):Theme: to improve patient care by preparing systematic reviews to improve cost-effectiveness and best practice in gynaecological cancer and associated cancer care which will inform national guidelines and local protocols. The gynaecological oncology community has some priority issues to deal with in the near future some of which will be addressed by the completion and publication of the reports from a study looking at screening the general population for ovarian cancer (UKCTOCS). Also the UK CHORUS trial comparing surgery before and during chemotherapy for ovarian fallopian tube or primary peritoneal cancer completed recruitment in August 2010; the full results are due for publication in 2012. Another important area is the findings of the recently reported EORTC report on neo-adjuvant chemotherapy followed by interval debulking surgery for ovarian cancer. The CGCRG will also consider the recently published NHS colposcopy and European cervical cancer guidelines. Scope: Current protocols vary widely from Network to Network. As with the previous application topics for potential reviews will be developed by a thorough prioritisation project involving Cancer Networks to identify areas where evidence is weak or missing.Proposed reviews to be undertaken and/or updated and how the choice is justified in terms of NHS priorities (2000 characters max):The ongoing Programme Grant has enabled us to develop a strategy to ensure relevant targeted titles are commissioned via expert partners including BGCS BSCCP RCOG NFGON Ovacome Jo’s Trust NICE CRD and NHS Programme Directors. A major prioritising process took place between June and September 2007 whereby we contacted representatives from the above organisations requesting their ‘top five’ priority reviews in gynaecological cancer. The response was overwhelming and resulted in a prioritisation meeting at King’s Fund in September 2007 where 20 titles were selected. The programme then actively sought to identify UK trainees in all aspects of gynaecological cancer care who were keen to conduct a systematic review and the titles were allocated to teams which included senior clinicians with proven Cochrane systematic review experience.These partners have enabled us to publish a tailored list of reviews on the Cochrane Library (see Appendix 2). Criteria for Prioritisation1) Improving patient outcomes2) Importance to NHS priorities3) Achievability and cost effectiveness4) Impact on efficacy and efficiency 5) Timeliness.For this proposal new strands of work (screening early recognition predictive factors diagnostics and prognostic methods) will be considered as well as generic themes such as surgery radiotherapy first and second line chemotherapy combined modality therapy communication supportive and palliative care organisation of care delivery rehabilitation and complimentary therapies. This enables the Group to also focus on the ‘orphan’ topics. We have also identified published protocols which would benefit from additional support to ensure timely publication of the full reviews.Updating reviews will form a large part of the work to ensure that the most up-to-date evidence is available. We will concentrate on those reviews on the Cochrane Library within our module which are accessed frequently and are cited most often (see Appendix 3).Outline plan and timetable for undertaking reviews including how award would be used (e.g. employment of new researchers) (2000 characters max):All review teams will undergo a comprehensive training programme established by the previous award. The training will focus on writing a protocol for a review: writing the background in plain English; specifying the inclusion criteria; primary and secondary outcomes and adverse events; search strategy; assessment of risk of bias; statistical methods for analysis of survival outcomes. As with the previous award we anticipate that numerous consultants specialist registrars and gynae-oncology nurses will benefit from this training. The feedback from the sessions run from 2007 to 2010 has been excellent with all review teams receiving additional mentoring via email/telephone follow up. Should this application prove successful the management team (comprising co-applicants methodologists MEs and TSC) will adopt the same strategy and will regularly monitor the progress of each review; prompt remedial action will be taken if tasks are not completed by proposed deadlines. We will recruit a Research Associate (67%FTE) responsible for updating the prioritised reviews from the Group’s portfolio and to provide this expert training and technical support to clinical review authors for the sifting and data extraction stages of new reviews. We will continue to employ a Cochrane methodologist/statistician (40%FTE) to provide training and support for statistical methods for reviews perform specialised aspects of data abstraction advise on statistical design analysis and interpretation and ensure statistical quality control. He will be supported by a senior statistician (2%FTE). An Information Scientist (50%FTE) will continue to design search strategies conduct searches manage reference management databases and import references to Review Manager. The prioritisation process will take place between March 2011 and June 2011 with new topics then allocated to interested NHS teams by July 2011. As with the current programme we will allow six to nine months from title registration to protocol publication. Completion of this phase is scheduled for July 2012. We will then publish the full reviews within 18 months to coincide with the end of the Grant period. Protocols already published by the Group which will be expedited by the Grant will be published according to the same time scale as will the titles selected for update. The Grant will therefore be used to support a minimum of 20 new reviews/updates on the Cochrane Library.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: CANCER AND NEOPLASMS