7 Implementation

7 Implementation

7.1 When NICE recommends a treatment 'as an option', the NHS must make sure it is available within 3 months of this guidance being published. This means that, if a patient has ovarian cancer and the doctor responsible for their care thinks that paclitaxel is the right treatment, it should be available for use, in line with NICE's recommendations.

7.2 Clinicians with responsibility for treating women with ovarian cancer should review their current practice in line with the guidance set out in Section 1.

7.3 Local guidelines, protocols or care pathways on the care of women with ovarian cancer should incorporate the guidance set out in Section 1.

7.4 To measure compliance locally with the guidance, the following criteria can be used. Further details on audit criteria are presented in Appendix D.

7.4.1 First-line chemotherapy (usually following surgery) in the treatment of ovarian cancer includes the options of paclitaxel in combination with a platinum-based compound or platinum-based therapy alone.

7.4.2 The choice of treatment for first-line chemotherapy for an individual woman with ovarian cancer is based on discussion between the woman and the responsible clinician regarding the risks and benefits of the options available. The following issues should be discussed: side-effect profiles of the alternative therapies, the stage of the woman's disease, the extent of surgical treatment of the tumour, and disease-related performance status.

7.4.3 Additional courses of treatment with the chosen chemotherapy regimen are offered to women following relapse after the initial (or subsequent) course of first-line treatment, if the extent and duration of the initial (or previous) response is adequate.

7.4.4 Paclitaxel is considered as second-line (or subsequent) treatment for women with ovarian cancer only if they have not received the drug previously as part of first-line treatment.

7.4.5 Only oncologists specialising in ovarian cancer supervise the provision of chemotherapy in ovarian cancer.

7.5 Local clinical audits on the management of ovarian cancer also could include measurement of compliance with accepted clinical guidelines or protocols or with the measures for the treatment of ovarian cancer that are suggested in Improving Outcomes in Gynaecological Cancers, Guidance on Commissioning Cancer Services.