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Source: data.gov.uk (2025-09-11)

National Ovarian Cancer Audit State of the Nation Report 2025. The National Ovarian Cancer Audit (NOCA) aims to evaluate the patterns of care and outcomes for women with ovarian cancer in England and Wales, and to support services to improve the quality of care for these women.
This State of the Nation report publishes information on the care received by 5,713 women diagnosed with ovarian cancer in England in 2022 and by 317 women diagnosed in Wales in 2023.

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National Ovarian Cancer Audit 
State of the Nation Report 2025
An audit of care received by women diagnosed with ovarian cancer between 1 January 2022 
and 31 December 2022 in England and 1 January 2022 and 31 December 2023 in Wales.
Published September 2025

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Citation for this document: 
National Ovarian Cancer Audit (NOCA) 
State of the Nation Report 2025. London: 
National Cancer Audit Collaborating Centre, 
Royal College of Surgeons of England, 2025.
This report was prepared by members of the NOCA project team:
Sudha Sundar, NOCA Clinical Lead (surgery)
Agnieszka Michael, NOCA Clinical Lead (oncology)
Jan Van Der Meulen, NOCA Lead Methodologist
Ipek Gurol-Urganci, NOCA Senior Methodologist
Andrew Hutchings, NOCA Methodologist
Georgia Zachou, NOCA Clinical Fellow
Rui Wu, NOCA Clinical Fellow
Joanne Boudour, NOCA Senior Project Manager
Aurelia Chen, NOCA Project Coordinator
With review and input from: 
NOCA Clinical Reference Group 
NATCAN Executive Team
The Royal College of Surgeons of England (RCS) is an independent professional body committed 
to enabling surgeons to achieve and maintain the highest standards of surgical practice and 
patient care. As part of this it supports audit and the evaluation of clinical effectiveness for surgery. 
Registered Charity no: 212808.
The National Cancer Audit Collaborating Centre (NATCAN) is commissioned by the Healthcare Quality 
Improvement Partnership (HQIP) and funded by NHS England and the Welsh Government as part of the 
National Clinical Audit and Patient Outcomes Programme (NCAPOP). NATCAN delivers national audits 
in bowel, breast (primary and metastatic), kidney, lung, non-Hodgkin lymphoma, oesophago-gastric, 
ovarian, pancreatic and prostate cancers.
ICAL 
The British Gynaecological Cancer Society (BGCS) is the professional home of health providers 
working and researching the area of gynaecological cancers. The BGCS members consist of medical 
practitioners, clinical nurse specialists and other allied professionals, including scientists who have 
an interest in gynaecological cancers. Registered Charity no: 290959.
This work uses data that has been provided by patients and collected by the NHS as part of their care 
and support. For patients diagnosed in England, the data is collated, maintained and quality assured 
by the National Disease Registration Service (NDRS), which is part of NHS England. Access to the 
data was facilitated by the NHS England Data Access Request Service.
NHS Wales is implementing a new cancer informatics system. As a result, the quality and 
completeness of data from Wales is likely to have been impacted due to implementation of this new 
system across multiple NHS organisations (Health Boards), which has resulted in data being supplied 
by both old and new systems. Additionally, and reflecting the uncertainty of data quality, the data 
submitted to the audit may not have undergone routine clinical validation prior to submission to the 
Wales Cancer Network (WCN), Public Health Wales.
© 2025 Healthcare Quality Improvement Partnership (HQIP)
Copyright All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether 
or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written 
permission to reproduce any part of this publication should be addressed to the publisher.

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Contents
1.	
Introduction	
4
­2.	
Infographic	
7
3.	
Recommendations	
8
4.	
Result for England and Wales	
11
4.1	
Data	
11
Patient cohort	
11
Data completeness	
11
Patient characteristics	
11
4.2	 Performance indicators	
13
Performance indicator 1: Emergency admission prior to diagnosis	
13
Performance indicator 2: Receipt of any treatment (surgery and/or chemotherapy) for 
women with emergency admission prior to diagnosis	
13
Performance indicator 3: Receipt of any treatment (surgery and/or chemotherapy)	
13
Performance indicator 4: Receipt of platinum-based chemotherapy	
14
Performance indicator 5: One-year survival	
14
Performance indicator 6: Two-year survival	
14
5.	
Commentary	
16
NOCA Quality Improvement Intervention/Initiative	
17

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1.	 Introduction
1	
Ovarian cancer can affect all people with ovaries, including those who have had their ovaries removed, as it can also affect the fallopian tubes or the peritoneum. In this report, 
all the patients are referred to as ‘women’, but we acknowledge that some patients with ovarian cancer may not identify as women. The data we receive from NDRS include 
all patients with ovarian cancer who, according to the data, self-identify as female, but we do not receive the data for patients with ovarian cancer who identify as male.
2	
Ledermann J A, Matias-Guiu X, Amant F, Concin N, Davidson B, Fotopoulou C, et al. ESGO–ESMO–ESP consensus conference recommendations on ovarian cancer: 
pathology and molecular biology and early, advanced and recurrent disease. Ann Oncol. 2024 Mar;35(3):248-266..
3	
Moss E, Taylor A, Andreou A, Ang C, Arora R, Attygalle A, et al. British Gynaecological Cancer Society (BGCS) ovarian, tubal and primary peritoneal cancer guidelines: 
Recommendations for practice update 2024. European Journal of Obstetrics & Gynecology and Reproductive Biology. 10.1016/j.ejogrb.2024.06.025.
The National Ovarian Cancer Audit (NOCA) aims 
to evaluate the patterns of care and outcomes for 
women with ovarian cancer in England and Wales, 
and to support services to improve the quality of 
care for these women1. This State of the Nation 
(SotN) report publishes information on the care 
received by women diagnosed with ovarian cancer 
in England in 2022 and in Wales in 2022-2023.
In this report, we present a national picture 
in England and Wales. Please go to NOCA’s 
Data Dashboard for results of each of the 40 
gynaecological cancer systems in England and 
the three systems in Wales. There are also results 
for cancer alliances, individual NHS trusts and 
health boards available on the dashboard.
New developments
This is the audit’s second annual assessment of 
ovarian cancer services provided by the NHS. 
The new elements in this report include: 
•	 Two new indicators in this year’s SotN report:
ׂ	 Receipt of any treatment (surgery and/
or chemotherapy) for women with 
emergency admission prior to diagnosis
ׂ	 Two-year survival 
•	 Implementation of a formal outlier process, linked 
to the one-year survival performance indicator, 
requesting hospitals with a performance indicator 
outside the expected range to review the relevant 
data on practice outcomes and to feedback to 
NOCA the findings of this review.
•	 Introduction of NOCA’s Quality Improvement 
Intervention/Initiative, which will be launched in 
October 2025.
NOCA has also worked with England’s National 
Disease Registration Service (NDRS) and the Wales 
Cancer Network (WCN), updating the cohort of 
patients and aiming to use as recent data as possible 
depending on the requirement of each performance 
indicator (see Table 1). Although this report is being 
published in September 2025, it includes data on 
women diagnosed with ovarian cancer in England in 
2022, the latest year of available NCRD registration 
data, and in Wales in 2023, the latest year for 
which data is available. More details regarding 
the timeliness of the data can be found here.
Relevant clinical guidance
As explained in last year’s SotN report, NOCA aims 
to evaluate the care for women with ovarian cancer 
informed by various national guidelines. NOCA 
evaluates ovarian cancer care against standards 
derived from national guidelines for ovarian cancer 
(NG12 & CG122) that were published by the National 
Institute for Health and Clinical Excellence (NICE). 
These guidelines include recommendations for 
the early recognition of symptoms of ovarian 
cancer, the referral pathway, and the treatment 
of early (stage 1) and advanced (stage 2 to 4) 
cancer. International2 and national3 professional 
societies have also published recommendations 
on the management of ovarian cancer.
More recently, NICE published interventional 
procedures guidance (IPG757) on maximal 
cytoreductive surgery, which supports the use of 
this surgery in accredited specialised centres for 
women with advanced ovarian cancer. Guidelines 
on managing familial and genetic risk were 
published in 2024 by NICE and the British 
Gynaecological Cancer Society (BGCS). Finally, 
NICE has published several technology appraisals 
on chemotherapy treatment of early and relapsed 
ovarian cancer. Also a number of appraisals are still 
in progress.
Quality improvement goals 
In consultation with key stakeholders, including 
women with lived experience of ovarian cancer and 
NOCA’s Clinical Reference Group, we recognise 
five quality improvement goals. Further information 
regarding these quality improvement goals can 
be found in NOCA’s Quality Improvement Plan. 
The six performance indicators reported in this 
year’s SotN report align as much as possible 
with these quality improvement goals.

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Accompanying materials available 
on NOCA’s website:
Additional materials that accompany this report 
include:
A methodology supplement with details about the 
Audit’s data sources and methods
•	 An online glossary that explains technical terms 
used in this report
•	 Information about the outlier process
•	 Resources to support local monitoring of practice 
and quality improvement, such as provider-level 
results on the Data Dashboard and downloadable 
reports and a local action plan template. 
•	 A summary of this report for women with ovarian 
cancer and for the public is available on the 
Audit’s website.
Data sources
 The Audit derives its indicators using information 
that is routinely collected by the NHS as part of 
the care and support given to women diagnosed 
with ovarian cancer, rather than data collected 
specifically for the Audit4. For people diagnosed or 
treated in England, the data are collated, maintained 
and quality assured by NHS England’s National 
Disease Registration Service (NDRS). For people 
diagnosed or treated in Wales, data are provided by 
Wales Cancer Network (WCN)5, using the Cancer 
Network Information System Cymru (CaNISC) or 
Cancer Dataset Form (CDF). For full details of the 
data and methods used within this report, please 
see the NOCA Methodology Supplement.
4	
The audits in NATCAN do not ‘collect’ clinical data. The cancer audits utilise the nationally mandated flows of data from hospitals to the National Disease Registration 
Service (NDRS) in NHSE and the Wales Cancer Network in Public Health Wales, thereby minimising the burden of data collection on provider teams. 
5	
NHS Wales is part way through a cancer informatics implementation programme which is designed to improve the data capture and reporting capabilities of NHS Wales. 
This ongoing implementation is impacting the data quality within NHS Wales in the short term with multiple systems being used and different implementation dates 
across cancer sites and organisations resulting in a complex data landscape. NHS Wales has committed to continue to submit audit data annually until data submissions 
are sourced exclusively from the new cancer informatics solution. This will be from 2027 onwards that NHS Wales will be able to supply quarterly data using this new 
integrated, and more accessible digital platform.
6	
The presence of specific variants in BRCA genes increases a woman’s chance of developing ovarian cancer.
Interpretation of the audit results
When interpreting differences between England and 
Wales and between gynaecological cancer hub and 
spoke systems, it is important to note that only the 
one- and two-year survival indicators are adjusted 
for potential differences in case-mix (e.g. age, 
stage, grade, morphology, ethnicity, socioeconomic 
deprivation status, comorbidity, and frailty). We 
are not yet able to adjust for important cancer 
characteristics, such as BRCA6 or homologous 
recombination deficiency (HRD) status.
One limitation in developing case-mix adjustment 
is the completeness of key patient and tumour 
characteristics recorded in national cancer 
registration systems. These characteristics include 
cancer stage and grade, morphology based on 
histology or cytology as well as the patient’s 
performance status. 
National Cancer Audit Collaborating Centre 
(NATCAN)
NOCA is part of NATCAN, the national centre that 
aims to strengthen NHS cancer services by looking 
at treatments provided for cancer patients and 
their outcomes across England and Wales. The 
centre is commissioned by the Healthcare Quality 
Improvement Partnership (HQIP) on behalf of 
NHS England and the Welsh Government. More 
information about the ten national cancer audits for 
England and Wales delivered by NATCAN can be 
found at NATCAN’s website.

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Table 1. * Performance Indicators Included
England^
Wales#
PI1: Emergency admission prior to diagnosis
Yes (01/22 – 12/22)
Yes (01/23 – 12/23)
PI2: Receipt of any treatment (surgery and/
or chemotherapy) for women with emergency 
admission prior to diagnosis
Yes (01/22 – 12/22)
Yes (01/23 – 12/23)
PI3: Receipt of any treatment (surgery and/or 
chemotherapy)
Yes (01/22 – 12/22)
Yes (01/23 – 12/23)
PI4: Receipt of platinum-based chemotherapy
Yes (01/22 – 12/22)
No (data not available)
PI5: One-year survival from the date of 
diagnosis
Yes (01/22 – 12/22)
Yes (01/23 – 12/23)
PI6: Two-year survival from the date of 
diagnosis
Yes (01/22 – 09/22)
Yes (01/22 – 12/22)
Performance indicators not currently reported
PI7: Germline panel testing 
No (data not available)
No (data not available)
PI8: HRD testing 
No (data not available)
No (data not available)
PI9: Receipt of cytoreductive surgery
No (in development)
No (data not available)
*See methodology supplement for the exact definitions of each performance indicator
^England data: National Cancer Registration Dataset (NCRD)
#Welsh data: Cancer Network Information System Cymru (CaNISC)

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of women diagnosed with stage 
2 to 4 or unstaged ovarian 
cancer in England (E) in 2022 
and in Wales (W) in 2023 had 
any treatment recorded (surgery 
and/or chemotherapy).
Approximately one out of three women diagnosed in England 
in 2022 with stage 2 to 4 or unstaged epithelial ovarian cancer 
did not have any platinum-based chemotherapy recorded.
Receipt of any treatment (surgery 
and/or chemotherapy)
Platinum-based chemotherapy
(excluding borderline ovarian tumours)
Diagnosis
Stage 1: 22.7%
Stage 2: 6.8%
Stage 3: 38.6%
Stage 4: 31.9%
Stage in England in 2022
Stage 1: 23.1%
Stage 2: 5.8%
Stage 3: 46.9%
Stage 4: 24.2%
Stage in Wales in 2023
(based on those with complete staging information - 77.0% in England and 92.7% in Wales)
Mean age at diagnosis
Wales in 2023
England in 2022
(based on crude estimates and it does not account for differences in case-mix) 
Stage at diagnosis
Emergency admissions
Approximately four out of ten women diagnosed in 
England in 2022 and in Wales in 2023 had an emergency 
admission within 28 days prior to diagnosis.
of women who had an 
emergency admission 28 
days prior to ovarian cancer 
diagnosis in England (E) in 
2022 and in Wales (W) in 2023 
had any treatment recorded.
Receipt of any treatment (surgery and/or chemotherapy) 
for women with emergency admission prior to diagnosis
Two-year survival
Survival
One-year survival
of women diagnosed with ovarian cancer in 
England in 2022 and in Wales in 2023 survived 
at least one year after the diagnosis.
of women diagnosed with ovarian cancer in England 
between 1st January and 30th September 2022 and 
in Wales between 1st January and 31st December 
2022 survived at least two years after the diagnosis.
Summary of results for women diagnosed with ovarian cancer 
in England (2022) and Wales (2022-2023) 
70.2%
England
73.8%
Wales
57.8%
England
67.6%
Wales
5,713
61.3%
71.0%
317
diagnoses of ovarian 
cancer in England in 2022
diagnoses of ovarian 
cancer in Wales in 2023
66.3
years
66.3
years
74.2%
80.3%
­2.	 Infographic

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Recommendation
Audience
Audit findings
Quality Improvement Goal
National guidance/standards/resources
Clinical Recommendations
1.	 Reduce the current rate of emergency 
admissions:
•	 NHS England and the Wales Cancer 
Network to continue working with 
gynaecological cancer systems, 
Cancer Alliances, health boards, 
and primary care organisations 
to explore the use of innovative 
approaches to early diagnosis in 
community settings, and including:
ׂ	 Gynaecological cancer systems, 
Cancer Alliances, health boards 
to continue engaging with their 
local populations alongside 
ovarian cancer charities to improve 
recognition of ovarian cancer 
symptoms, particularly among 
older adults and those living in 
more deprived areas.
ׂ	 Referring hospitals to review 
cases of emergency admissions 
to identify potential missed 
opportunities and share learning 
with primary care partners to 
support earlier diagnosis in the 
future.
England: 
NHS England, Cancer 
Alliances working with 
gynaecological cancer 
systems7 and NHS trusts.
Wales: 
health boards working with 
gynaecological cancer 
systems.
Performance indicator 1:
40.1% of women diagnosed 
in England in 2022 and 41.3% 
diagnosed in Wales in 2023 
had an emergency admission 
within 28 days prior to diagnosis 
(lowest percentage 29.9% and 
highest 52.0% across the 40 
gynaecological cancer systems 
in England; lowest percentage 
33.3% and highest 47.4% across 
three gynaecological cancer 
systems in Wales).
Goal #1: Increase the 
proportion of patients 
receiving timely diagnosis 
and treatment decisions.
Women can be diagnosed late with advanced 
disease due to delays in presenting for medical 
care, difficulties in access to care, delays in primary 
care, or delays in secondary care8. The short-term 
mortality report from the Ovarian Cancer Audit 
Feasibility Pilot (OCAFP) showed that women 
diagnosed via an emergency presentation were 
four times more likely to die within two months 
of diagnosis than those diagnosed via the urgent 
suspected cancer referral system. 
Our data show that approximately 40% of women 
with ovarian cancer have an emergency admission 
28 days prior to diagnosis which implies that there 
is considerable scope to improve outcomes by 
enhancing symptom awareness, increasing access 
to primary care and increasing the number of 
women diagnosed through rapid access pathways. 
Symptom triggered testing and fast track pathways 
are associated with low volume disease and early-
stage diagnosis9. Promoting awareness amongst 
women and health care professionals in primary 
care through collaboration with cancer alliances and 
cancer charities will facilitate this.
7	
The main organisational unit for audit reporting is the gynaecological cancer system. This was recommended as a level for reporting performance indicators in the British Gynaecological Cancer Society’s recommendations for evidence-based, population 
data derived quality performance indicators for ovarian cancer. This choice of unit acknowledges that decisions about ovarian cancer care are not always attributable to an individual NHS Trust such as the trust or hospital where a woman is diagnosed. It 
also avoids the problem of reporting indicators for individual trusts or hospitals that may diagnose a small number of patients each year.
8	
 Abel GA, Mendonca SC, McPhail S, Zhou Y, Elliss-Brookes L, Lyratzopoulos G. Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data. Br J Gen Pract. 2017 Jun;67(659):e377-e387.
9	
Kwong FLA, Kristunas C, Davenport C, Deeks J, Mallett S, Agarwal R, et al. Symptom-triggered testing detects early stage and low volume resectable advanced stage ovarian cancer. International Journal of Gynecological Cancer Published Online First: 13 
August 2024. doi: 10.1136/ijgc-xx-xxxx-xxxx.
3.	 Recommendations
Recommendations developed in collaboration with NOCA Clinical Reference Group and based on key findings in this report.

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Recommendation
Audience
Audit findings
Quality Improvement Goal
National guidance/standards/resources
2.	 Investigate why women diagnosed 
with ovarian cancer within 28 days 
following an emergency admission 
did not receive any treatment (surgery 
and/or chemotherapy) and aim to 
reduce that proportion by: 
•	 engaging with NOCA’s Quality 
Improvement Intervention/Initiative.
•	 performing a detailed case-note 
review to identify the reasons why 
women did not receive treatment.
•	 assessing eligibility for 
treatment based on the women’s 
pre-admission fitness and 
consider timely involvement of 
prehabilitation service.
•	 ensuring close collaboration 
between the centre and the units 
within a gynaecological cancer 
system. 
England: 
Cancer Alliances working 
with gynaecological cancer 
systems and NHS trusts.
Wales: 
health boards working with 
gynaecological cancer 
systems.
Performance indicator 2:
61.3% of women in England 
in 2022 and 71.0% of women 
in Wales in 2023 who had 
an emergency admission 28 
days prior to ovarian cancer 
diagnosis had any treatment 
(surgery and/or chemotherapy) 
recorded between one month 
prior and three months following 
diagnosis (lowest percentage 
46.2% and highest 81.8% 
across the 40 gynaecological 
cancer systems in England; 
lowest percentage 62.2% and 
highest 75.8% across three 
gynaecological cancer systems 
in Wales).
Goal #1: Increase the 
proportion of patients 
receiving timely diagnosis 
and treatment decisions 
Goal #3: Increase the 
proportion of patients 
receiving surgery.
Goal #4: Increase the 
proportion of patients 
receiving chemotherapy.
Surgery and platinum-based chemotherapy is the 
standard of care for women with ovarian cancer.
Our data show that approximately 40% of women 
who have an emergency admission prior to their 
diagnosis do not have any treatment recorded within 
3 months of diagnosis.
3.	 Review the percentage of women 
with stage 2 to 4, or unstaged ovarian 
cancer who receive treatment (any 
type), explore and address some 
of the reasons behind the variation 
across gynaecological cancer 
systems by:
•	 performing a detailed case-note 
review to identify why women did 
not receive any treatment.
•	 documenting whether women 
eligible for treatment were offered 
it and the reasons for not treating, if 
appropriate.
England:
Cancer Alliances working 
with gynaecological cancer 
systems.
Wales:
health boards working with 
gynaecological cancer 
systems.
Performance indicator 3:
74.2% of women in England 
in 2022 and 80.3% in Wales 
in 2023 who were diagnosed 
with stage 2 to 4, or unstaged 
ovarian cancer had any 
treatment (i.e., surgery and/
or chemotherapy) recorded 
between one month prior and 
nine months following diagnosis 
(lowest percentage 62.0% and 
highest 87.8% across the 40 
gynaecological cancer systems 
in England; lowest percentage 
75.0% and highest 82.1% across 
three gynaecological cancer 
systems in Wales).
Goal #3: Increase the 
proportion of patients 
receiving surgery.
Goal #4: Increase the 
proportion of patients 
receiving chemotherapy.
Surgery and platinum-based chemotherapy is 
the standard of care for these women. The short-
term mortality report from the OCAFP showed that 
22.2% of all women with ovarian cancer, regardless 
of stage, did not have any treatment recorded 
between one month prior and nine months following 
diagnosis. Those women were also more likely to 
die within 2 months following diagnosis (56.9%) than 
women who received treatment. 
The NHS Cancer Programme and the Cancer 
Alliance Treatment Variation Working Group have set 
the recommended treatment rate for these women 
at 80%.

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Recommendation
Audience
Audit findings
Quality Improvement Goal
National guidance/standards/resources
4.	 Identify opportunities to increase 
the utilisation of platinum-based 
chemotherapy in women with 
epithelial ovarian cancer (stage 
2 to 4, or unstaged), explore and 
address some of the reasons behind 
the variation across gynaecological 
cancer systems by:
•	 performing a detailed case-note 
review to identify why women did 
not receive any chemotherapy.
•	 documenting whether women 
eligible for treatment were offered 
it and the reasons for not treating, if 
appropriate.
•	 assessing eligibility for 
treatment based on the women’s 
pre-admission fitness and 
consider timely involvement of 
prehabilitation service.
England:
Cancer Alliances working 
with gynaecological cancer 
systems.
Performance indicator 4:
66.0% of women diagnosed 
in England in 2022 with stage 
2 to 4, or unstaged epithelial 
ovarian cancer were recorded 
as receiving platinum-based 
chemotherapy one month 
prior to three months following 
diagnosis (lowest percentage 
44.7% and highest 83.8% 
across the 40 gynaecological 
cancer systems in England)10. 
Goal #4: Increase the 
proportion of patients 
receiving chemotherapy.
First-line chemotherapy treatment in ovarian cancer 
should include a platinum-based compound either in 
combination or as a single agent.
5.	 Review one-year survival in women 
diagnosed with ovarian cancer, 
explore and address some of the 
reasons behind the variation across 
gynaecological cancer systems by:
•	 taking into account the 
performance of gynaecological 
cancer systems across the 
previous indicators.
•	 identifying key pressure points in 
the ovarian cancer care pathway.
England:
Cancer Alliances working 
with gynaecological cancer 
systems.
Wales:
health boards working with 
gynaecological cancer 
systems.
Performance indicator 5:
70.2% of women diagnosed 
in England in 2022 and 73.8% 
in Wales in 2023 were alive at 
least one year after diagnosis 
(lowest percentage 58.4% 
and highest 86.9% across the 
gynaecological cancer systems 
in England; lowest percentage 
67.9% and highest 76.0% across 
three gynaecological cancer 
systems in Wales).
Goal #5: Improve rates of 
survival and reduce variation 
in survival.
One-year net survival according to the profile 
and treatment report from the OCAFP in women 
diagnosed between 2015 and 2019 in England was 
68.4%. An international study has demonstrated 
similar results and has reported  that one-year 
net survival in women diagnosed between 2010 
and 2014 in the UK was 70.3% which lags behind 
countries with similar health systems11, i.e., Australia 
78.5%, Canada 72.6%, Denmark 77.4%, New 
Zealand 71.5%, and Norway 77.5%.
10	
This performance indicator was not available for Wales due to absence of data for chemotherapy regimens..
11	
Arnold M, Rutherford MJ, Bardot A, Ferlay J, Andersson TM, Myklebust TÅ, et al. Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol. 2019 
Nov;20(11):1493-1505.

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4.	 Result for England and Wales
4.1	 Data
Patient cohort
7,391 women aged 18 years and older with newly 
diagnosed ovarian cancer in the NHS (7,000 in 
England in 2022 and 391 diagnosed in Wales 
in 2023) were eligible to be included. Of these 
women, 850 (12.1%) in England and 41 (10.5%) in 
Wales had a diagnosis not based on histology or 
cytology. In England, 1,997 (28.5%) women did 
not have their cancer stage at diagnosis recorded 
and this was the case for 33 (8.4%) in Wales.
We report on the care provided to 6,043 women with 
ovarian cancer (n=5,713 in England, n= 317 in Wales) 
after excluding women with borderline tumours or 
whose ovarian cancer diagnosis was based on death 
certificate only (n=1,287 in England, n=74 in Wales).
Data completeness
Key messages: For women with ovarian 
cancer, information recorded in national 
datasets regarding stage (England), grade and 
performance status was below the target of 
90% completeness.
Treatment options for women with ovarian cancer 
are influenced by the characteristics of their cancer 
(stage and grade at diagnosis) and their general 
health and fitness. The recording of this information 
in national cancer datasets is vital to understand 
patterns of care. Levels of completeness were 
good for ethnicity in England and stage in Wales 
but fell below the 90% target for other data items 
(see Table 2), particularly stage in England, grade, 
performance status, and ethnicity in Wales.
Table 2. Data completeness for women with newly 
diagnosed ovarian cancer in England in 2022 and Wales in 
2023.
Completeness
Item
England 2022
(n=5,713)
Wales 2023
(n=317)
Ethnicity
90.4%
51.7%
Stage
77.0%
92.7%
Grade*
78.1%
n/a
Performance status
63.8%
87.4%
*237 morphologies were excluded from the denominator as grading does not 
apply to them
Patient characteristics
Key messages: Approximately three out 
of four women with ovarian cancer were 
diagnosed with stage 2 to 4 disease in 
England and in Wales.
NOCA included 6,030 women diagnosed with 
ovarian cancer in England in 2022 (n=5,713) 
and Wales in 2023 (n=317) and a summary of 
their characteristics is given in Table 3. Please 
note that women with borderline tumours were 
not included. Mean age at diagnosis was 66.3 
years (IQR: 57-77) in England and 66.3 years 
(IQR: 57-76) in Wales. Of the women who had 
their performance status recorded, 1,968 out of 
3,646 in England (54.0%) and 94 out of 277 in 
Wales (33.9%) were reported as “fully active”.
In England, 77.3% of women with a recorded 
stage had stage 2 to 4 ovarian cancer and the 
corresponding percentage was 76.9% of women 
in Wales. In England, 78.2% of women with a 
recorded grade had a high-grade ovarian cancer. 
The majority of women had epithelial ovarian 
cancer (82.6% in England and 81.4% in Wales).

Copyright © 2025 Healthcare Quality Improvement Partnership (HQIP)
9
Table 3. Characteristics of women diagnosed with ovarian cancer in England in 2022 and Wales in 2023.
England 2022
Wales 2023
Number of women
5,713
317
Age at diagnosis (years)
18-29
2.0%
1.3%
30-39
3.2%
2.8%
40-49
7.3%
5.7%
50-59
17.4%
20.5%
60-69
23.5%
26.2%
70-79
28.1%
29.0%
>79
18.6%
14.5%
Index of multiple deprivation quintile
1 - most deprived
16.1%
15.1%
2
18.9%
16.7%
3
20.9%
22.1%
4
21.7%
23.1%
5 - least deprived
22.4%
23.1%
Not recorded (E=0, W=18)
Performance status (reported E=3,646, W=277)
0 - fully active
54.0%
33.9%
1
29.1%
44.0%
2
9.3%
11.6%
3
6.0%
7.6%
4 - bedbound
1.7%
2.9%
Not recorded (E=2,067, W=40)
Stage at diagnosis (reported E=4,408, W=294)
Stage 1
22.7%
23.1%
Stage 2
6.8%
5.8%
Stage 3
38.6%
46.9%
Stage 4
31.9%
24.2%
Not recorded (E= 1,315, W= 23)
Grade (reported E=4,511, W=n/a)
Low
11.2%
n/a
Moderate
5.4%
n/a
High
78.2%
n/a
Not graded
5.3%
n/a
Not recorded (E=1,202, W=n/a) 
Morphology
Malignant epithelial
82.6%
81.4%
Clear cell carcinoma
4.0%
4.4%
Endometrioid carcinoma
5.6%
7.3%
Mucinous carcinoma
5.5%
6.0%
Other malignant epithelial
12.2%
9.8%
Serous carcinoma
55.3%
53.9%
Miscellaneous & unspecified
9.5%
12.6%
Non-specific site
2.5%
3.5%
Sex cord-stromal & germ cell
5.4%
2.5%
E = England, W = Wales, n/a = not available, percentages are rounded to the first decimal.

Copyright © 2025 Healthcare Quality Improvement Partnership (HQIP)
10
4.2	 Performance indicators
Performance indicator 1: Emergency admission 
prior to diagnosis
Key messages: Approximately four out of 
ten women in England and in Wales had 
an emergency admission 28 days prior to 
diagnosis.
Of the 5,713 women with ovarian cancer diagnosed 
in England in 2022, 2,288 (40.1%) had an emergency 
admission within 28 days prior to diagnosis. Of 317 
women diagnosed in Wales in 2023, 131 (41.3%) 
had an emergency admission. These data indicate 
that their symptoms immediately before diagnosis 
were so severe or that there were difficulties in 
access to care, delays in primary care, or delays in 
secondary care12 which made access to acute care 
necessary. This percentage varied across the 40 
gynaecological cancer systems in England from 
29.9% to 52.0% and across the three gynaecological 
cancer systems in Wales from 33.0% to 47.4%. 
Performance indicator 2: Receipt of any treatment 
(surgery and/or chemotherapy) for women with 
emergency admission prior to diagnosis
Key messages: Approximately four out of ten 
women in England and three out of ten women 
in Wales who had an emergency admission 
28 days prior to ovarian cancer diagnosis did 
not have any treatment recorded  within three 
months of diagnosis.
Of the 2,288 women who had an emergency 
admission 28 days prior to ovarian cancer 
diagnosis in England in 2022, 1,403 (61.3%) 
received any type of treatment (surgery and/or 
chemotherapy) between one month before and 
three months after the recorded date of diagnosis. 
Of the 131 women who had an emergency 
admission 28 days prior to diagnosis in Wales in 
2023, 93 (71.0%) received any type of treatment. 
This percentage varied across the 40 
gynaecological cancer systems in England from 
46.1% to 81.8% and across the three gynaecological 
cancer systems in Wales from 62.2% to 75.8%.
Considerable variation exists in the utilisation of 
any treatment (surgery and/or chemotherapy) 
recorded for women who had an emergency 
admission 28 days prior to ovarian cancer 
diagnosis across the gynaecological cancer 
systems in England and Wales (Figure 1).
Figure 1. Unadjusted funnel plot for the proportion of 
women diagnosed with ovarian cancer within 28 days of an 
emergency admission receiving any treatment (surgery and/
or chemotherapy).
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Women who received any treatment (%)
0
50
100
150
Number of women with emergency admission
English system*
Welsh system*
National percentage
95% limits
99.8% limits
Any treatment within 3 months for emergency admissions
There are three cancer systems above the upper 95% control limit, but none is 
above the upper 99.8% limit and two systems below the lower 95% limit, with 
none falling below the lower 99.8% limit. 
* system refers to the gynaecological cancer system.
Performance indicator 3: Receipt of any 
treatment (surgery and/or chemotherapy)
Key messages:  Approximately one out of four 
women newly diagnosed with stage 2 to 4 or 
unstaged ovarian cancer in England, and one 
in five in Wales, did not have any treatment 
recorded within nine months of diagnosis.
For women with stage 2 to 4 or unstaged ovarian 
cancer, 3,496 of 4,714 (74.2%) diagnosed in England 
in 2022, and 200 of 249 (80.3%) diagnosed in 
Wales in 2023 received any type of treatment 
(surgery and/or chemotherapy) between one month 
before and nine months after the recorded date of 
diagnosis. This percentage varied across the 40 
gynaecological cancer systems in England from 
62.0% to 87.8% and across the three gynaecological 
cancer systems in Wales from 75.0% to 82.1%.
12	
Abel GA, Mendonca SC, McPhail S, Zhou Y, Elliss-Brookes L, Lyratzopoulos G. Emergency diagnosis of cancer and previous general practice consultations: insights from 
linked patient survey data. Br J Gen Pract. 2017 Jun;67(659):e377-e387.

Copyright © 2025 Healthcare Quality Improvement Partnership (HQIP)
11
Performance indicator 4: Receipt of platinum-
based chemotherapy
Key messages:  Approximately one out of 
three women newly diagnosed in England 
with stage 2 to 4 or unstaged epithelial 
ovarian cancer were not recorded as 
receiving platinum-based chemotherapy 
within three months of diagnosis.
With respect to women with stage 2 to 4 or 
unstaged epithelial ovarian cancer, 2,594 
of 3,931 (66.0%) received platinum-based 
chemotherapy in England in 2022 between one 
month before and three months after the recorded 
date of diagnosis. Information about type of 
chemotherapy was not available for Wales. This 
percentage varied across the 40 gynaecological 
cancer systems from 44.7% to 83.8%.
Performance indicator 5: One-year survival
Key messages:  Approximately seven out of 
ten women diagnosed with ovarian cancer 
survived at least one year after diagnosis in 
England and three out of four in Wales.
Of the 5,713 women diagnosed with ovarian 
cancer in England in 2022, 4,009 (70.2%) 
survived at least one year after diagnosis, and 
this was the case for 234 of the 317 women 
(73.8%) diagnosed in Wales in 2023.
Overall, one-year survival varied across the 40 
gynaecological cancer systems in England from 
58.4% to 86.9% and across the three 
gynaecological cancer systems in Wales from 
67.9% to 76.0%. It is important to note that these 
system-specific results are not adjusted for 
differences in case-mix (e.g. age, stage, grade, 
morphology, deprivation status, performance 
status, and comorbidity), which may account for 
some of the differences in survival between 
England and Wales and between the 
gynaecological cancer systems.
We then adjusted the results to account for 
differences in case-mix. The adjusted one-year 
survival estimates account for differences in age, 
stage, grade, morphology, socio-economic 
deprivation, ethnicity, comorbidities, and frailty. 
Even after adjustment, considerable variation in 
one-year survival remains across the 
gynaecological cancer systems in England and 
Wales (Figure 2.).
Figure 2. Risk-adjusted funnel plot showing the proportion 
of women with ovarian cancer who are alive at least one year 
following their diagnosis across the gynaecological cancer 
systems.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
50
100
150
200
250
300
350
400
Number of women
English system*
Welsh system*
National percentage
95% limits
99.8% limits
Risk−adjusted 1−year survival
Women who survived at least 1 year (%)
One gynaecological cancer system is above the upper 95% control limit, but none 
is above the upper 99.8% limit. Four systems are below the lower 95% limit, with 
none falling below the lower 99.8% limit. This performance indicator is subject to 
our outlier process. 
* system refers to the gynaecological cancer system. 
Risk-adjusted results account for differences in the case-mix.
Performance indicator 6: Two-year survival
Key messages:  Approximately four out of 
seven women diagnosed with ovarian cancer 
survived at least two years after diagnosis in 
England and two out of three in Wales.
Of the 4,328 women diagnosed with ovarian cancer 
in England between 1st January 2022 and 30th 
September 2022, 2,502 (57.8%) survived at least two 
years after diagnosis . Of the 293 women diagnosed 
with ovarian cancer in Wales between 1st January 
2022 and 31st December 2022, 198 (67.6%) survived 
at least two years after diagnosis. Overall two-year 
survival varied across the 40 gynaecological cancer 
systems in England from 44.7% to 80.1% and across 
the three gynaecological cancer systems in Wales 
from 64.9% to 69.4%.
We then adjusted the results to account for 
differences in case-mix. The adjusted two-year 
survival estimates account for differences in 
age, stage, grade, morphology, socio-economic 
deprivation, ethnicity, comorbidities, and frailty. 
Adjusted two-year survival was 57.9% for women 
diagnosed with ovarian cancer in England and 62.8% 
for women diagnosed with ovarian cancer in Wales. 
Overall two-year adjusted survival varied across the 
40 gynaecological cancer systems in England from 
44.9% to 68.7% and across the three gynaecological 
cancer systems in Wales from 62.0% to 65.1%. Even 
after adjustment, considerable variation in two-year 
survival remains across the gynaecological cancer 
systems in England and Wales.

Copyright © 2025 Healthcare Quality Improvement Partnership (HQIP)
12
Table 4. Performance indicators of women diagnosed with ovarian cancer in England in 2022 and Wales in 2023
England 2022
Wales 2023
Number
Percentage
Number
Percentage
Performance indicator 1*: 
Women diagnosed with ovarian 
cancer who had an emergency 
admission within 28 days prior 
to diagnosis.
Denominator: 
Women diagnosed 
with ovarian cancer 
(excluding borderline 
tumours).
2,288/5,713
40.1%
131/317
41.3%
Lowest: 29.9%
Highest: 52.0%
Lowest: 33.3%
Highest: 47.4%
Performance indicator 2: 
Women diagnosed with ovarian 
cancer within 28 days of an 
emergency admission who 
receive any type of treatment 
(surgery and/or chemotherapy) 
one month prior to three 
months following diagnosis.
Denominator:  
Women diagnosed 
with ovarian 
cancer who had an 
emergency admission 
within 28 days prior 
to diagnosis cancer 
(excluding borderline 
tumours).
1,403/2,288
93/131
71.0%
Lowest: 46.1%
Highest:81.8%
Lowest: 62.2%
Highest: 75.8%
Performance indicator 3: 
Women diagnosed with stage 
2 to 4 or unstaged ovarian 
cancer who receive any type 
of treatment (surgery and/
or chemotherapy) one month 
prior to nine months following 
diagnosis.
Denominator:  
Women diagnosed 
with stage 2 to 4 or 
unstaged ovarian 
cancer (excluding 
borderline tumours).
3,496/4,714
74.2%
200/249
80.3%
Lowest: 62.0%
Highest: 87.8%
Lowest: 75.0%
Highest: 82.1%
Performance indicator 4: 
Women diagnosed with stage 
2 to 4 or unstaged epithelial 
ovarian cancer who receive 
platinum-based chemotherapy 
one month prior to three 
months following diagnosis.
Denominator:  
Women diagnosed 
with stage 2 to 4 or 
unstaged epithelial 
ovarian cancer 
(excluding borderline 
tumours).
2,594/3,931
66.0%
n/a
n/a
Lowest: 44.7%
Highest: 83.8%
n/a
Performance indicator 5: 
Women diagnosed with ovarian 
cancer who are alive one year 
following the diagnosis.
Denominator: 
Women diagnosed 
with ovarian cancer 
(excluding borderline 
tumours).
4,009/5,713
70.2%
234/317
73.8%
Lowest: 58.4%
Highest: 86.9%
Lowest: 67.9%
Highest: 76.0%
England 2022**
Wales 2022
Performance indicator 6: 
Women diagnosed with ovarian 
cancer who are alive two years 
following the diagnosis.
Denominator: 
Women diagnosed 
with ovarian cancer 
(excluding borderline 
tumours).
2,502/4,328
57.8%
198/293
67.6%
Lowest: 44.7%
Highest: 80.1%
Lowest: 64.9%
Highest: 69.4%
 * For performance indicator 1, a lower value indicates better performance.
** For performance indicator 6, the cohort included women diagnosed with ovarian cancer in England between 1st January 2022 and 30th September 2022 as data 
required to estimate survival outside this period were unavailable.
Borderline: Borderline malignant (“borderline”) ovarian tumours have historically been recorded as ovarian cancers, though their malignant potential is now understood to 
be lower than the rest of the group. 
Difference between England and Wales should be interpreted with caution as these results are not adjusted for differences in case-mix and confidence intervals are 
expected to be wide due to the smaller number of patients in Wales.

Copyright © 2025 Healthcare Quality Improvement Partnership (HQIP)
13
5.	 Commentary
This is the second NOCA SotN report, where 
we provide a summary of our analysis of six 
performance indicators covering four quality 
improvement goals (Table 4). As indicated 
above, results for each gynaecological cancer 
system in England and in Wales are available 
on NOCA’s Dashboard. Most indicators include 
women newly diagnosed with ovarian cancer 
in England in 2022 and in Wales in 2023.
Provider level results for certain indicators are 
currently available on a quarterly basis (curated 
using ‘Rapid Cancer Registry’ data) through an 
interactive online dashboard, enabling providers 
to reflect on more timely data. In addition to these, 
results from this annual report (curated using ‘Gold 
standard’ data) have been added to this dashboard. 
The results reflect NOCA’s ambition captured in the 
Quality Improvement Plan, also taking into account 
the limitations of the availability and completeness 
of relevant national data. We expect that the Quality 
Improvement Plan will gradually develop over time 
in response to improvements in data availability.
We found that the recording of stage, grade and 
performance status was missing for a considerable 
number of women. We will continue working with 
NDRS in England and WCN in Wales in order to 
improve the completeness of these data items, 
which are essential for the evaluation of ovarian 
cancer care. We also encourage the ovarian cancer 
care providers to identify areas for improvement 
in data completeness and accuracy. For example, 
it would be helpful if clinicians ensure on a regular 
basis in their own hospital that the data reported 
on their behalf are both complete and accurate.
Our SotN report demonstrates that:
•	 Four out of ten women in England and in Wales 
had an emergency admission in the 28 days prior 
to their ovarian cancer diagnosis. Women 
admitted as an emergency have worse cancer 
outcomes than women diagnosed via non-
emergency routes. This highlights the urgency to 
review and where possible improve the timeliness 
of the diagnostic and referral pathways of ovarian 
cancer within the Cancer Alliances and Welsh 
Health Boards and increase symptom awareness 
amongst patients and primary care professionals. 
•	 Four out of ten women in England and in Wales 
who had an emergency admission 28 days prior 
to their ovarian cancer diagnosis did not have any 
treatment recorded within three months of 
diagnosis. This category of women tends to have 
worse survival outcomes compared to women 
who receive treatment. NOCA considers this 
indicator of great clinical importance and will 
launch a nationwide Quality Improvement 
Intervention/Initiative in October 2025 aiming to 
improve the rates of treatment for these women. 
This initiative will have to take into account that 
some of these women might not receive treatment 
because of their poor clinical condition resulting 
from advanced malignancy or because of 
personal choice.
•	 One out of four women newly diagnosed in 
England or in Wales with stage 2 to 4 or with 
unstaged ovarian cancer did not have any 
treatment recorded within nine months of 
diagnosis. Although some women might not 
receive treatment because of their poor clinical 
condition resulting from advanced malignancy or 
because of personal choice, this audit finding 
suggests that there are women whose cancer is 
potentially undertreated. This seems to be an 
ongoing issue, first highlighted in the geographic 
variation report by OCAFP, which included women 
diagnosed with stage 2 to 4 or with unstaged 
ovarian cancer in England between 2016 and 
2018, of whom 73.8% had any treatment 
recorded. Therefore, further investigations are 
required to understand better how and to what 
extent the number of women not receiving 
treatment can be increased.
•	 One out of three women newly diagnosed in 
England with stage 2 to 4 or unstaged epithelial 
ovarian cancer did not receive platinum-based 
chemotherapy within three months of diagnosis. 
These data were not available for Wales. This 
highlights that the NICE guidance for 
chemotherapy in ovarian cancer, recommending 
platinum-based chemotherapy for all these 
women, is not always being followed. Again, 
possible explanations could be that some women 
are in a very poor clinical condition or that some 
women are potentially undertreated.
•	 Seven out of ten women diagnosed with ovarian 
cancer survived at least one year after diagnosis 
in England and three out of four in Wales. The 
 difference between England and Wales and 
between the gynaecological cancer systems 
should be interpreted with caution as these 
results are not adjusted for differences in case-
mix (especially stage, grade, performance status, 
comorbidity, socio-economic deprivation). 
Adjusted one-year survival results are presented 
in the funnel plot (Figure 2.) and can also be 
found on NOCA’s Dashboard and Data tables. 
These results have been adjusted for differences 
in age, stage, grade, morphology, socio-economic 
deprivation, ethnicity, comorbidities, and frailty. 
However, adjustment for BRCA or HRD status was 
not possible due to lack of available data. This is a 
considerable limitation as the use of poly-ADP 

Copyright © 2025 Healthcare Quality Improvement Partnership (HQIP)
14
ribose polymerase inhibitors, known as PARP 
inhibitors, in women with BRCA mutations or HRD 
positive cancers appears to provide long-term 
enduring responses. This performance indicator 
is subject to our outlier process. In this year’s 
SotN report, there were no outliers.
•	 Four out of seven women diagnosed with ovarian 
cancer survived at least two years after diagnosis 
in England and two out of three in Wales. Again, 
differences between England and Wales and 
between the gynaecological cancer systems 
should be interpreted with caution as these 
results are not adjusted for differences in case-
mix. 
Following adjustment, considerable variation 
across the gynaecological cancer systems 
remain. The case-mix adjustment approach was 
similar to the one used for one-year survival and 
is subject to the same limitations.
Despite issues with data completeness, we are 
confident that the six clinical indicators published 
in this SotN report are clinically relevant and 
methodologically robust. Therefore, we encourage 
ovarian cancer care providers in England and Wales 
to respond to our five clinical recommendations. 
NOCA’s Data Dashboard and data tables provide 
the results for each gynaecological cancer 
system. We envisage that the national and local 
results based on the six indicators can also be 
used by patient charities and support groups 
when they have conversations with cancer care 
providers about how ovarian cancer care can 
be further improved. In addition, women, their 
families and wider support systems may want 
to consider our findings when they discuss 
their treatment options with their clinicians. 
As in last year’s SotN report, we did not report on 
three performance indicators that are mentioned 
in NOCA’s Quality Improvement Plan. These 
indicators relate to germline panel and homologous 
recombination deficiency testing (BRCA 1/2 and/
or genomic instability) as well as cytoreductive 
surgery. NOCA expects to be able to report on these 
three indicators in forthcoming reports when data 
necessary to derive these indicators will become 
available for analysis. In this year’s SotN report, two 
new indicators, performance indicators 2 and 6, 
have been introduced. Although they are not part 
of NOCA’s Quality Improvement Plan, they reflect 
NOCA’s commitment to evolve and adjust to clinical 
priorities after consulting with key stakeholders. 
In addition, for performance indicators 3 and 4, 
we have introduced time limits to the numerator.
Going forward, NOCA will continue to develop its 
SotN report alongside the quarterly reports. NOCA 
is developing its case-mix adjustment methodology 
for the other five performance indicators, and case-
mix adjusted results for these will be included in 
future reports. A key developmental priority for the 
forthcoming years is to develop clinical, statistical 
and data science approaches to address missing 
data on patient and tumour characteristics. NOCA 
is also committed to producing research outputs 
that align closely with its aims and ambitions. 
These research activities will help inform and 
shape future reports, and support and guide 
Quality Improvement Interventions/Initiatives for 
ovarian cancer care in England and Wales.
NOCA Quality Improvement Intervention/
Initiative
In October 2025, NOCA will launch a Quality 
Improvement Intervention/Initiative aimed at 
increasing the percentage of women with an 
emergency admission prior to their ovarian 
cancer diagnosis who receive any type of 
treatment (surgery and/or chemotherapy). This 
initiative has been developed in consultation with 
key stakeholders, including women with lived 
experience of ovarian cancer who are members 
of NOCA’s Patient and Public Involvement Forum 
and a wider range of stakeholders represented 
in NOCA’s Clinical Reference Group.
NOCA has presented the Quality Improvement 
Intervention/Initiative in webinars and conferences13. 
In this way, NOCA aims to engage with the clinical 
community and stimulate sharing best practice.
We aim to evaluate the impact of the Quality 
Improvement Intervention/Initiative using rapid 
registration data published in the quarterly 
reports. These data will enable evaluation 
of the intervention’s effectiveness.
13	
British Gynaecological Cancer Society, Annual Scientific Meeting – London, July 2025