Informatics and Ovarian Cancer Care

Informatics and Ovarian Cancer Care

Laurie Elit (McMaster University, Canada), Susan Bondy (University of Toronto, Canada), Michael Fung-Kee-Fung (University of Ottawa, Canada), Prafull Ghatage (University of Calgary, Canada), Tien Le (University of Ottawa, Canada), Barry Rosen (University of Toronto, Canada) and Bohdan Sadovy (Princess Margaret Hospital, Canada)
Copyright: © 2009 |Pages: 77
DOI: 10.4018/978-1-60566-078-3.ch012
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Abstract

Ovarian cancer affects 2,400 women annually in Canada with a case fatality ratio of 0.70. There are several practice guidelines that indicate women with early stage ovarian cancer should be appropriately staged including removal of the gynecologic organs, multiple peritoneal biopsies, and pelvic and paraaortic lymphadenectomy. In advanced disease, removing as much disease as possible and leaving less than a centimeter of residual disease in any one area improves overall duration of survival in cohort studies. Single institution studies and now work using administrative datasets in many high resource countries, show that women are not receiving adequate surgical staging or debulking. Cancer Care Ontario has used the RAND approach for defining quality indicators as a step for evaluating quality of care for several cancers including the management of women with ovarian cancer. The difficulty with current administrative datasets in the province is the lack of specific information such as stage, grade, histology, and size of residual disease. In this chapter, we will elaborate on the research that has brought ovarian cancer care to this juncture. We will highlight the importance of gathering information at the point of procedures and specifically in ovarian cancer at the point of the operation. Problems with the operative note and mechanisms to overcome these using templates, checklists, and synoptic notes will be reviewed. We will provide examples of pilot studies in Canada using synoptic operative notes in Cancer Care Alberta and Princess Margaret Hospital. We will also provide examples of computerized data entry across the spectrum of care from three projects in Ontario, Canada. Issues in building a disease site-specific electronic medical record will be discussed. The problems experienced in attempting to generalize such a system provincially will be addressed. We will elaborate on the potential benefits to the individual patient, the hospital and the province from such information system.
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Introduction

Ovarian cancer (OC) is the fifth leading cause of cancer death in women and the leading cause of gynecologic cancer mortality. In 2007, there were estimated to be 2400 new cases diagnosed in Canada (Marrett, L., Dryer, D., Logan, H. et al., 2007) with a case fatality ratio of 0.70. The most common form of OC arises from the epithelial surface cells of the ovary.

The standard of care for malignant epithelial OC is surgery followed by adjuvant chemotherapy. Surgery plays a key role in the management of OC. Surgery is necessary for diagnosis, which includes determining the origin of the disease (i.e., ovary, colon, pancreas) and defining the histologic type of disease (i.e., epithelial, germ cell, or stromal type tumors) (A-1). This information influences a patient’s prognosis and choice of adjuvant therapy. Surgery defines the extent of intra-abdominal disease; this is otherwise known as staging (A-2). The extent of disease spread or stage of disease at diagnosis is a major determinant of prognosis. Chemotherapy is administered after surgery when the disease has spread beyond the ovary. Surgery is also the means by which tumor is debulked to the smallest size possible. The size of the smallest tumor bulk in any one site in the abdomen at the completion of surgery influences the patient’s prognosis. A standard operation to stage and debulk the tumor has been defined (National Institute of Health, 1994-1995; Trimbos, J. B., & Bolis, G., 1994; Allen, D. G., Baak, J., Belpomme, D., et al., 1993; Hoskins, W., Rice, L., & Rubin, S., 1997; Morgan, R. J., Copeland, L., Gershenson, D., et al., 1996; Trimbos, J. B., Schueler, J. A., van Lent, M., Hermans, J., & Fleuren, G. J., 1990).

Unfortunately, there is evidence that women are not being appropriately staged or optimally debulked and this can impact on their survival. Various efforts are a foot to improve the care of women diagnosed with ovarian cancer. In this chapter we will build the case for the use of informatics as a tool to reinforce completion of certain aspect of the operation and by collecting accurate detailed information, improving the data from which decisions are made concerning quality assurance. This will optimize the operative care to women with ovarian cancer by improving the accuracy and completeness of data collection at surgery.

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Editorial Advisory Board
Table of Contents
Foreword
Neil Pattison
Preface
Emma Parry, David Parry
Acknowledgment
Emma Parry, David Parry
Chapter 1
Peter Stone
Improving women’s health is a vital task for the world. The consequences of obstetric and gynecological disease are serious both for the women... Sample PDF
An Introduction to Women's Health and Informatics
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Chapter 2
Premila Fade
Principlism (derived from common sense morality) is the most common theory used within the healthcare sphere. The elements of this theory are... Sample PDF
Women's Health Informatics: The Ethical and Legal Issues
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Chapter 3
David Parry
Recording information about symptoms, observations, actions, and outcomes is a key task of health informatics. Standardization of records is vital... Sample PDF
Coding and Messaging Systems for Women's Health Informatics
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Chapter 4
Gareth Parry
Women’s health in primary care is a large part of the generalist’s practice. Information technology (IT) is now an integral part of the generalist’s... Sample PDF
Women's Health Informatics in the Primary Care Setting
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Chapter 5
Emma Parry
The seamless electronic health record is often hailed as the holy grail of health informatics. What is an electronic health record? This question is... Sample PDF
The Electronic Health Record to Support Women's Health
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Chapter 6
Graham Parry
Information technology and communication systems have made imaging in women’s health easier at many levels. There are now many commercial systems on... Sample PDF
Imaging and Communication Systems in Obstetrics and Gynecology
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Chapter 7
Emma Parry
Pregnancy is unique in medicine in providing a discrete event with a fixed end. It is well suited to data collection and statistical assessment.... Sample PDF
Statistical Measures in Maternity Care
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Chapter 8
Kiran Massey, Tara Morris, Robert M. Liston
Our ultimate goal as obstetric and neonatal care providers is to optimize care for mothers and their babies. As such, we need to identify practices... Sample PDF
Building Knowledge in Maternal and Infant Care
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Chapter 9
Malcolm Battin, David Knight, Carl Kuschel
Neonatal care is an extremely data-intensive activity. Physiological monitoring equipment is used extensively along with web-based information tools... Sample PDF
Informatics Applications in Neonatology
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Chapter 10
Jenny Westgate
During pregnancy the fetus requires an adequate supply of oxygen and clearance of carbon dioxide which is a waste product of metabolism. In fetal... Sample PDF
Computerizing the Cardiotocogram (CTG)
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Chapter 11
Liron Pantanowitz
Automation and emerging information technologies are being adopted by cytology laboratories around the world to augment Pap test screening and... Sample PDF
Computer Assisted Cervical Cytology
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Chapter 12
Laurie Elit, Susan Bondy, Michael Fung-Kee-Fung, Prafull Ghatage, Tien Le, Barry Rosen, Bohdan Sadovy
Ovarian cancer affects 2,400 women annually in Canada with a case fatality ratio of 0.70. There are several practice guidelines that indicate women... Sample PDF
Informatics and Ovarian Cancer Care
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Chapter 13
Jamila Abuidhail
Information and communication technologies include computers, telecommunication, digital networks, and television. Using informatics in healthcare... Sample PDF
Women's Health and Health Informatics: Perinatal Care Health Education
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Chapter 14
Shona Kirtley
In an age where health professionals lead very busy working lives, electronic information sources provide ease of access to vast amounts of health... Sample PDF
Electronic Information Sources for Women's Health Knowledge for Professionals
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Chapter 15
David Parry
Decision analysis techniques attempt to utilize mathematical data about outcomes and preferences to help people make optimal decisions. The... Sample PDF
Computerised Decision Support for Women's Health Informatics
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Chapter 16
Michelle Brear
The influence of organizational factors on the success of informatics interventions in healthcare has been clearly demonstrated. This health... Sample PDF
Organizational Factors: Their Role in Health Informatics Implementation
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Chapter 17
Josipa Kern
When things go well then often it is because they conform to standards (ISO, 2005). According to the Oxford Dictionary of Modern English, there is a... Sample PDF
Standardization in Health and Medical Informatics
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Chapter 18
Elske Ammenwerth, Stefan Gräber, Thomas Bürkle, Carola Iller
This chapter summarizes the problems and challenges which occur when health information systems are evaluated. The main problem areas presented are... Sample PDF
Evaluation of Health Information Systems: Challenges and Approaches
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Chapter 19
Pirkko Nykänen
eHealth refers to use of information and communication technologies to improve or enable health and healthcare. eHealth broadens the scope of health... Sample PDF
eHealth Systems, Their Use and Visions for the Future
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Chapter 20
Nilmini Wickramasinghe, Santosh Misra, Arnold Jenkins, Douglas R. Vogel
Superior access, quality and value of healthcare services has become a national priority for healthcare to combat the exponentially increasing costs... Sample PDF
The Competitive Forces Facing E-Health
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About the Contributors