Diagnosis, treatment and burden in advanced ovarian cancer: a UK real-world survey of healthcare professionals and patients

<b>Aim:</b> Little is known regarding uptake of epithelial ovarian cancer (EOC) treatments or patient burden in UK real-world practice. <b>Methods:</b> Cross-sectional surveys of patients with advanced EOC and healthcare professionals (HCPs). <b>Results:</b> 101 HCPs and 142 patients participated. Time from initial primary care consultation to diagnosis was ∼7 weeks. 83% patients were offered hereditary genetic testing, with 89% uptake. 53% HCPs reported surgery was performed ≤1 month in non-neoadjuvant setting. Surgery delay negatively impacted patient quality of life (61%), mental health (89%), and surgical outcomes (63%). 56% patients received active first-line maintenance treatment; patients on active surveillance had greater emotional/psychological distress. <b>Conclusion:</b> Treatment delays and low uptake of active first-line treatment should be addressed. Emotional support must be readily accessible throughout treatment. New treatments for ovarian cancer mean that patients could be treated and live with the disease for many years. However, not much is known about the treatments that are actually received by patients with ovarian cancer in real-life. These surveys were done to learn more about the treatment and experience of patients with ovarian cancer in the UK. 101 healthcare professionals (HCPs) and 142 patients took the surveys. The surveys found that patients usually waited about 7 weeks from their first GP visit to diagnosis of ovarian cancer. Half of HCPs reported that patients had surgery within 1 month of the decision that surgery was needed. HCPs reported that delays in surgery had a negative impact on patient quality of life, mental health, and the success of the surgery. After finishing their first line of chemotherapy, about half of patients had a maintenance treatment to control their ovarian cancer and give them as long as possible between recurrences. The remaining patients were not given treatment but were watched for further signs of cancer. Patients on maintenance treatment experienced less emotional/psychological distress than those managed by watchful waiting. This survey shows that more needs to be done to make sure that patients with ovarian cancer in the UK are diagnosed and treated quickly and offered the right treatment. Emotional support should be available to patients during their treatment. Little is known about the uptake of treatments for epithelial ovarian cancer (EOC) in UK real-world practice or the corresponding burden on patients and healthcare systems. This non-interventional, cross-sectional survey of 142 patients with advanced EOC and 101 healthcare professionals (HCPs) was undertaken to characterise the patient journey and quality of life (QoL) impact of EOC from the perspective of both the patient and the HCP. Patient-reported time from initial primary care consultation to diagnosis was ∼7 weeks, which was dissatisfactory to 17% patients. Around four in five patients were offered hereditary (germline) genetic testing (mainly BRCA1/2), with high uptake of the offer (around three in four patients). 53% HCPs reported that surgery takes place within 1 month of the decision in non-neoadjuvant patients (92% in total within 2 months). A large proportion of HCPs noted that delays in surgery also have a considerable impact on patients' QoL (61% of HCPs), mental health (89%) and also impact surgical outcomes detrimentally (63%). Only 56% of patients reported receiving an active first-line maintenance treatment, with the remainder on active surveillance only; a greater proportion of patients on active surveillance experienced high levels of emotional/psychological distress compared with patients on active first-line maintenance treatment. HCPs reported that performance status, side effects and the patient's own preference were the main reasons why active surveillance was chosen over an active first-line maintenance therapy. Treatment delays and low uptake of active first-line treatment should be addressed among patients with EOC in the UK. Emotional support must be readily accessible throughout treatment.

**研究目的**：目前对于英国真实临床实践中上皮性卵巢癌（epithelial ovarian cancer, EOC）治疗方案的采用情况，以及患者所承受的疾病负担，尚缺乏充分认知；同时，关于卵巢癌患者在真实临床场景中实际接受的治疗方案，相关研究也较为匮乏。本研究旨在深入了解英国卵巢癌患者的治疗方案与诊疗体验。
**研究方法**：针对晚期上皮性卵巢癌患者与医疗专业人员（healthcare professionals, HCPs）开展横断面调查，属于非干预性研究，旨在从患者与医疗专业人员双视角，刻画上皮性卵巢癌患者的诊疗路径，以及该疾病对患者生活质量（quality of life, QoL）的影响。本次调查共纳入142例晚期上皮性卵巢癌患者与101名医疗专业人员。
**研究结果**：本次调查共纳入101名医疗专业人员与142例患者。患者自述从首次全科医师（GP）就诊到确诊的时长约为7周，其中17%的患者对该等待时长表示不满。约83%的患者被建议接受遗传性基因检测，其中89%的患者接受了检测；另有约80%的患者被推荐接受遗传性（生殖系）基因检测（主要为BRCA1/2基因检测），该类检测的整体接受率较高，约75%的参与患者完成了检测。53%的医疗专业人员报告，非新辅助治疗患者的手术在手术决策做出后1个月内完成；整体而言，92%的手术均在决策后2个月内完成。手术延迟的负面影响显著：61%的医疗专业人员认为手术延迟会对患者的生活质量产生负面影响，89%的医疗专业人员认为会损害患者的心理健康，另有63%的医疗专业人员认为会对手术结局产生不利影响。仅56%的患者报告接受了一线积极维持治疗，其余患者仅接受主动监测；与接受一线积极维持治疗的患者相比，仅接受主动监测的患者出现更高水平的情绪/心理困扰。医疗专业人员表示，体能状态、不良反应以及患者自身意愿是选择主动监测而非一线积极维持治疗的主要原因。
**研究结论**：英国上皮性卵巢癌患者群体中仍存在治疗延迟、一线积极治疗接受率偏低的问题，亟需针对性改进。同时，在整个诊疗过程中，应为患者提供便捷可及的情绪支持服务。随着卵巢癌新型治疗方案的问世，患者可在带瘤状态下长期生存，但目前对于真实临床场景中患者实际接受的治疗方案仍缺乏充分认知。本次横断面调查明确了晚期上皮性卵巢癌患者的诊疗路径与疾病负担，可为优化英国卵巢癌患者的诊疗管理提供科学依据。