The recommendations with resource implications are discussed in Annex 3.

11.1 Managed clinical networks

Managed Clinical Networks (MCNs) are defined as: ‘linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a coordinated manner, unconstrained by existing professional and Health Board boundaries, to ensure equitable provision of high quality clinically effective services throughout Scotland.’ ¹⁷⁸

MCNs require an administrative infrastructure so they have financial implications. In the case of ovarian cancer, the core members of the MCN would be allied health professionals, gynaecological oncologists, general practitioners, laboratory medicine specialists, gynaecologists, medical and clinical oncologists, nurses, pathologists, radiologists and palliative care specialists.

The health professionals involved in the care of women with ovarian cancer should be represented in a managed clinical network.

11.2 Recommendations for research

Surgical and chemotherapy research questions need to be answered by large randomised controlled trials. Patients should be entered into appropriate clinical trials wherever possible (eg MRC, EORTC, GOG and the Scottish Gynaecological Cancer Trials Group). Seven other areas where evidence is lacking have been identified in the course of developing this guideline:

1. Does measurement of CA125 in primary care for patients with recent onset non-specific abdominal symptoms increase the likelihood of detecting ovarian cancer?
2. Do delayed referrals from primary care impact upon survival?
3. Does input and support from a Clinical Nurse Specialist impact on the quality of life of patients with ovarian cancer?
4. What is the impact on quality of life for women undergoing prophylactic surgery because of a strong family history of ovarian cancer?
5. What are the relative effects of best supportive care versus chemotherapy in patients with relapsed disease?
6. What is the best follow up regimen for women with ovarian cancer?
7. Does input from a palliative medicine specialist impact upon quality of life in the management of malignant bowel obstruction?