Appendix D. Detail on criteria for audit of the use of paclitaxel in the treatment of women with ovarian cancer

Appendix D. Detail on criteria for audit of the use of paclitaxel in the treatment of women with ovarian cancer

Possible objectives for an audit

An audit on the treatment of ovarian cancer could be carried out to ensure that:

  • paclitaxel is used appropriately

  • women with ovarian cancer participate in making the choice concerning their therapy

  • chemotherapy for women with ovarian cancer is supervised by an appropriate specialist.

Patients to be included in an audit

All women undergoing treatment for ovarian cancer over a reasonable time period, for example, 1 year. For measures 3 and 4 below, it may be useful to include women who were diagnosed and begun on chemotherapy sufficiently long ago that relapses and second-line therapy may have occurred.

Measures that can be used as a basis for audit

The measures that can be used in an audit are as follows:

Criterion

Standard

Exception

Definition of Terms

1. Paclitaxel in combination with a platinum-based compound or platinum-based therapy alone is offered for first-line chemotherapy

100% of women with ovarian cancer

A. None

First-line = usually following surgery. Platinum-based compound = cisplatin or carboplatin

2. The choice of treatment for first-line chemotherapy is based on discussion between the patient and the responsible clinician

100% of women with ovarian cancer

None

Local specialists should agree on how discussion with the woman about the risks and benefits of the options available is documented, for audit purposes. Reference should be made to 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

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

100% of women with ovarian cancer who received first-line chemotherapy and who have experienced a relapse

A. Inadequate or too short a duration of initial response

B. The woman declines treatment following discussion with the responsible clinician

Local specialists should agree on how to judge the adequacy and duration of initial response, for audit purposes

4. Paclitaxel is considered as second-line (or subsequent) treatment

0% of women with ovarian cancer

A. The woman has not received paclitaxel previously as part of first-line treatment

5. The provision of chemotherapy is supervised by an oncologist specialising in ovarian cancer

100% of women with ovarian cancer

None

Local specialists should agree on what constitutes supervision, for audit purposes

Calculation of compliance with the measures

Compliance with the measure described in the table is calculated as follows.

Number of patients whose care is consistent with the criterion plus the number meeting any applicable exceptions

/

Number of patients in the audit to which the Criterion and Exception(s), where applicable, apply

X 100

Clinicians should review the findings of measurement, identify if practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that desired improvement is being achieved.