Chris O’Brien Lifehouse is a leading specialist gynaecological cancer hospital. Its gynaecological, ovarian, cervical, uterine, vaginal cancer research cancer research programme helps patients to access cutting edge treatments that deliver the best possible outcomes.
A key area of gynaecological ovarian cervical uterine vaginal cancer research for our unit has been fast-track surgery (FTS), a multimodal approach to the management of surgical patients, which requires the successful organisation of all members of the health care team. Two studies were carried out to explore patients’ experience and satisfaction with FTS and with the Fast Track Nurse (FTN). A self-administered satisfaction questionnaire incorporating the European Organisation for Research and Treatment of Cancer (EORTC) cancer in-patient satisfaction with care measure (INPATSAT-32) questionnaire with additional questions was administered to 106 gynaecology participants. Participants reported high levels of satisfaction with patient care and support received from doctors, ward nurses and the hospital within the context of a fast-track surgical programme. The studies suggest that the advantages of a fast-track program support the idea of nurse coordination of treatment throughout surgery and the post discharge phase for gynecological oncology patients. Early hospital discharge after gynaecological surgery results in both enhanced recovery after surgery (ERAS) and high levels of patient satisfaction.
A further analysis of fast-track surgery compared fast-track open hysterectomy (FTOH) with total laparoscopic hysterectomy (TLH), a minimally invasive surgical approach to hysterectomy. Although the fast-track approach to open surgery minimizes its impact it is associated with a longer hospital stay than total laparoscopic hysterectomy albeit with lower cost of intraoperative consumables. This modelled analysis showed that the costs of both approaches are initially comparable but that the laparoscopic approach becomes cheaper once a learning curve of cases was completed. The average cost reduction following a learning curve was found $1850 per case, a significant cost saving.
Ovarian cancer, when in its early stage, can be difficult to detect or to differentiate from benign disease potentially leading to overtreatment of young women in particular. Another recent study by our department demonstrated the effectiveness of HE4 as a sensitive and specific marker for ovarian cancer which performed well when differentiating benign from malignant disease. Furthermore HE4 performed better than the traditional ovarian cancer marker (Ca125) in both pre- and post-menopausal women. The study demonstrated the utility of this marker in the assessment of indeterminate complex adnexal masses and may help to reduce the burden of surgery in younger women.