Discussion:
There are around 7,400 new ovarian cancer cases in the UK every year,
that’s 20 every day (2015-2017) with a 10 years survival of 35% .
Ovarian cancer is the 6th most common cancer, with around 7,300 new
cases in 2017.[10]
The estimated population of a country like Scotland is around 5.5
million with an average of 600 Ovarian cancer cases diagnosed each
year.[5,10]
In comparison the estimated population of Jordan is around 10 million
with an average of lass than 90 Ovarian cancer diagnosed each year
according to the ministry of health cancer registry.[2]
Table 3 summaries some demographic, Ovarian cancer risk factors and
cancer care differences between the 2 countries.
Based on the population, risk factors and the world wide 1:50 women life
time risk of developing Ovarian cancer, it is expected that Jordan
should register more than a 1000 ovarian cases annually. However,
according the ministry of health cancer registry, on average there are
less than 90 Ovarian cancer registered.[2]
It is obvious that we have a gap between the expected and the registered
cancer numbers.
How can we explain this gap? And what are the possible reasons
responsible for this gap?
Possible causes and suggested measures to enhance ovarian cancer
registration and care in Jordan :
Lack of awareness among health care professionals . This study
revealed a need to improve awareness among healthcare professionals
about risk factors, signs and symptoms of ovarian cancer. This can be
achieved through organising regular joint meetings, workshops and study
days for the primary care general practitioners and family medicine
doctors. Primary health care systems in many developed countries
established a clear guidelines to their health care professionals to
role ovarian cancer with tumour marker and pelvic ultrasound for women
over 50 years of age who present with symptoms suggestive of ovarian
cancer.[13]
Lack of community awareness : Ovarian cancer always gives
symptoms.[1,13] Unfortunately, these symptoms are often non-specific
and could be put down to many benign conditions like Irritable bowel
syndrome, until cancer develops into a more advanced stage resulting in
a poor prognosis. Several measures can be utilised to raise women’s and
public awareness of risk factors and symptoms of ovarian cancer. Regular
educational programmes to raise awareness can be broadcasted through
national and other media channels including social media. In addition,
informative leaflets and posters can be made available in hospitals,
universities and other healthcare institutions.
Under-reporting : There are several healthcare systems and
independent health care institutions in Jordan; Ministry of Health’
hospitals, Royal Medical Services’ hospitals, university-based
hospitals, and a large private sector. There is no standard robust
cancer reporting system in place to ensure all ovarian cancer cases are
being reported and registered in one single cancer registry. Reporting
forms should be available electronically, and completed by designated
cancer accountable healthcare professionals on monthly basis. Most
health boards in many developed countries developed national cancer
registration and analysis services responsible for cancer registration
and to support cancer epidemiology, public health, service monitoring
and research.[15]
Lack of standard timely cancer referral pathways : Delivering
timely cancer pathways is crucial for the following reasons: Despite
improving survival rates, cancer is the fourth leading cause of death in
the UK; Patients continue to present late to their doctors with their
symptoms, resulting in delayed referral; Once a patient has been
referred, they want to be told “It’s not cancer” as soon as possible
or have their treatment planned in a timely manner; Where the diagnosis
is cancer, a speedy diagnostic pathway is critical for 62 day
compliance. Achievement of the national cancer waiting times standards
is considered by patients and the public to be an indicator of the
quality of cancer diagnosis, treatment and care.[1,3,16,17]
Unfortunately, there is no equivalent standard referral pathways in
Jordan. This could result in some of patients having to wait for
prolonged periods, or not being referred to cancer units at all.
Implementing these standard pathways will contribute to enhancing
patient’s referral and care.
Lack of cancer tracking system : Cancer tracking is crucial to
ensure that cancer patients receive their care in a timely manner.It is
good practice for organisations to have in place staff, systems and
processes to ‘pull’ cancer patients along their diagnosis and treatment
pathways. Tracking list should enable tracking staff to see clearly
where each patient is in their cancer pathway, what next step(s) each
patient is awaiting and the deadline by which it needs to be done. It
should be clear which patients are currently at risk of missing a
milestone on their pathway[16]. Ovarian cancer patients in Jordan
receive their management, or parts of their management, in several
hospitals, and in different health sectors based on the availability of
the infrastructures and resources. Some patients will need to be
referred between these sectors with no single authority tracking the
care of these patients. Thus, increasing the risk of patients being lost
between these healthcare institutions.
Lack of cancer clinical networks : Linked groups of health
professionals and organisations from primary, secondary and tertiary
care, working in a co-ordinated manner to ensure equitable provision of
high quality clinically effective services. Cancer networks play a key
role in reconfiguring cancer services with improvement of survival
figures and patient experience.[18] Having this structure of
networking will have a positive impact on cancer patients care in
Jordan.