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.