Background Patients presenting with advanced ovarian cancer can be managed in a variety of ways. No clear selection algorithms exist to guide decision-making and there is significant geographical variation in practice. Decision-making takes place in specialist multidisciplinary team meetings (MDTs). We wanted to examine whether format and behaviour within these meetings could explain the geographical variation in treatment patterns seen in England Methods Observational study of five cancer centre MDTs over a six-week period. Data were recorded for overall MDT performance. The GO-MDT-MODe tool was used to provide a measure of participation and quality of case discussion for all cases of advanced ovarian cancer. MDT scores were correlated with surgical and survival data extracted from national audit data. Results A total of 870 case discussions, including 145 cases of advanced ovarian cancer, were observed. MDTs varied in structure, format and time allocation between centres. Cluster analysis showed significant variation in quality and participation of discussion between centres (p<0.0025) and this correlated with the proportion of patients in the wider cancer alliance undergoing surgery, but not with overall survival Conclusions We have shown that at least part of the variation in practice seen in the UK correlates with different behaviours within MDTs. Increasing time for discussion and encouraging participation from all staff groups may increase proportions of patients undergoing optimal treatment regimens.

Background Neoadjuvant therapy is increasingly used in the first-line setting in people with advanced endometrial cancer despite a paucity of evidence for this approach. Objective To systematically evaluate the literature in this area. Search Strategy Electronic searches of Ovid MEDLINE, Ovid Embase, Clinical trials.gov and the International clinical trials registry platform were performed for studies published between 1990 and 2021 comparing neoadjuvant therapy with upfront debulking surgery in Stage 3 or 4 endometrial cancers. Selection Criteria Studies reporting overall survival, progression free survival, adverse events and/or quality of life in those undergoing neoadjuvant therapy or upfront debulking. Data Collection and Analysis Odds ratios (OR) and log hazard ratios (HR) along with 95% confidence intervals (CI) were calculated and pooled for analysis. Risk of bias was assessed using the ROBINS-I tool. Main Results Eight non-randomised studies with a total of 50,510 patients were identified. These showed that patients undergoing primary chemotherapy had similar survival outcomes to those undergoing primary surgery (HR 1.26 (95% CI 0.95-1.69)). Fewer patients in the neoadjuvant group had surgery but those that did were less likely to be suboptimally cytoreduced (OR 0.24; 95% CI 0.21-0.28). Surgical morbidity was no different between the two approaches (OR 0.51, 95% confidence interval 0.08-3.25). However, the potential for bias in these studies is very high. Conclusion There is significant uncertainty as to whether the outcomes for those undergoing primary cytoreductive surgery or neoadjuvant chemotherapy in the presence of unresectable disease are better. Prospective reporting of outcomes is needed.

Objective The role of surgery for patients with advanced ovarian cancer is well established but wide variations in the percentage of patients undergoing surgery exist. Design Observational Study Setting The 19 cancer alliances in England, UK Methods We undertook a comparative analysis to examine the effects of rates of surgery on one and five year disease specific survival across the 19 English Cancer Alliances. We also undertook a propensity score analysis of a single cohort of patients with advanced ovarian cancer to compare patients who did, and did not, undergo surgery as part of their primary management. Main outcome measures Correlations between rates of surgery, demographics, and cancer alliance performance against one and five year survival Results In multivariable analysis, rates of surgery undertaken by a Cancer Alliance remained an independent predictor of both one and five year survival (correlation coefficient 0.81, and 0.70, respectively) although this relationship is likely non linear with optimal rates of surgery still to be defined. Using propensity score analysis a subgroup of patients who gain no benefit from surgery can be identified. Conclusions Overall survival of patients with advanced ovarian cancer is likely to be improved with an increase in overall rates of surgery however there are likely to be optimal maximal rates, above which patients will be disadvantaged. Mechanisms for identifying individual outcome predictions are required.

Objective: To review the effect of the COVID-19 pandemic on the presentation of Cervical cancer. Design/ Setting: Retrospective study involving the Regional Cancer Centres in the M62 Group. Methods: Data was collected for two equal time periods. All cervical cancers were included and FIGO 2018 staging was used for the data collection. P values were calculated using binomial hypothesis test for the difference in staging. Time from symptoms to diagnosis was assessed using a normal distribution test. All other calculations were performed using chi-squared test. Statistical significance was considered if p values were <0.05. Main outcome measures: Histology, stage at diagnosis, date of onset of symptoms, investigation and type of treatment. Results: A total of 406 cases of cervical cancer were reviewed; 233 from May – October 2019 (pre-COVID) and 173 between May – October 2020 (post COVID); representing a significant reduction in new cervical cancer diagnoses of 25% post COVID (p<0.001) There was a 42% increase in the delay from start of symptoms to diagnosis Post COVID. Pre COVID, 27% of patients presented with Stage 3 or 4 disease, whilst during COVID this was 38%; statistically significant (p <0.001). When we evaluated the treatments received between the two time periods, this was also statistically significant (chi-squared, p=0.0005). Conclusions: This study has demonstrated a statistically significant increase in the stage of cervical cancer at diagnosis and a change in treatment for cervical cancer following the onset of COVID-19. The implications of this are discussed.