Management of Vulval Cancer Services in South West England Jenny Weeks J Verne L Hirschowitz, V Udaysanker, AD Falconer on behalf SWCIS Gynaecology Tumour Panel September 2004

2 4 Cancer Networks Peninsula 3 Counties ASWCS Dorset SWIS Gynaecology Tumour Panel Multidisciplinary membership

3 Background Calman Hine Report 1995 Improving Outcomes Guidance Gynaecological Cancer 1999 SWCIS Regional Standards & Guidelines (Royal College Pathologists/ Obstetricians & Gynaecologists) -> improvement in care and outcomes ?

4 Aim of the Audit Monitor treatment against standards Have outcomes improved? UKCCR 2004

5 Standards Managed by gynaecologist with special interest in oncology (Regional/IOG) Minimum dataset recorded (IOG) eg Histological Type Grade ASA Groin nodes taken if Stage >IA (Regional) Skin - clear margins from tumour ≥ 8mm (Regional)

6 Method All new diagnoses squamous carcinoma of vulva (1997 to 2002) Data collected by gynaecology specialist nurses, gynaecologists, oncologists & audit departments Supplementary data from SWCIS information systems

7 Results 1997 – 2002: 435 cases squamous cell carcinoma (18 verrucous subtype) Surgery 80% radiotherapy 9% Stage I 33% Stage II 28% Stage III 16% Stage IV 6% not stated 16%

8 Age & Stage at diagnosis

9 % Surgery by ‘gynaecologist with oncology interests’

10 % Recorded (Min Data Set) CohortASAStageGrade %87%91% 99 – 0077%80%88% %83%92%

11 Width Tumour-free margins Ops/Cons

12 % operations ≥ 8mm margin by Consultant ‘activity level’ Ops/Cons

13 Nodes Taken (≥ Stage IB) Ops/Cons

to 2000 Kaplan-Meier survival estimates, by age category Ops/Cons Years since treatment <70years>70 and <80years >80 years

to 2000 Survivor functions, by stage adjusted for age Ops/Cons Years since treatment Stage IStage II Stage IIIStage IV not stated

to 2000 Survivor functions, by Treatment Year adjusted for age Years since treatment

17 Conclusion Centralisation of surgery has occurred Improvements in practice - not yet Improvements in outcome – too soon to say?

18 Thank you