Guideline 75: Epithelial ovarian cancer

Epithelial ovarian cancer
Annex 3

Resource implications of recommendations

A literature review was undertaken to identify relevant economic evaluations. Where these did not exist or where they were of poor quality, the recommendations were assessed by guideline development group members.

Guideline section	Recommendation		Likely resource implication
4.3.1		To minimise the need for a second operative staging procedure, intraoperative frozen-section assessment can be used to diagnose malignancy and to exclude metastatic disease.	Although this service is available in some centres, there is a national shortage of pathologists. Addressing the shortage of pathologists is a national issue. Undertaking such work is labour intensive for technicians and histopathologists which has an opportunity cost in terms of other work which may be delayed.
4.5		Patients with stage III disease should be operated on by a gynaecological oncologist rather than a general gynaecologist or general surgeon.	There are major resource implications due to the UK shortage of gynaecological oncologists. Addressing this shortage requires a UK-wide initiative to increase the number of trainees to ensure the shortfall is met. There would be associated costs of additional gynaecological oncologists including additional theatre sessions, dedicated beds, specialist nursing staff and other support staff. Guidance on Commissioning Cancer Services suggests that there should be one gynaecological oncologist per 500,000 population.¹⁸² For Scotland, this implies a minimum of 11 gynaecological oncologists.
7		Clinical trials should have appropriate inclusion criteria and should incorporate recognised standard treatment.	Clinical trials may have implications for the NHS in terms of: new efficacious agents being identified, which require to be continued in patients participating in the trial additional workload or opportunity costs of time foregone to treat other patients while undertaking the trial. This is covered to some degree by the NHS R&D support fund These may be balanced by the provision of new therapies that would not otherwise be available to patients.
10.1		Patients should be offered verbal and written information throughout their journey of care and should be made aware of the support mechanisms that are in place and how to access them. Structured emotional support should be available to all patients and carers.	More nurses with appropriate skills to provide information throughout the journey of care are required. There are implications for nurse training and for services offering emotional support to patients and their families.