Improving quality of care for patients with ovarian and endometrial cancer

This thesis was aimed at improving quality of care for patients with ovarian and endometrial cancer, with a focus on improving the organization of care and encouraging individualization of care.
Standard treatment for patients with advanced ovarian cancer comprises a combination of cytoreductive surgery and platinum-based chemotherapy. We showed that the implementation of a centralized care system and the introduction of neoadjuvant chemotherapy coincided with improved cytoreductive outcomes and overall survival. As centralization of care may induce treatment delays, we investigated health system intervals of patients suspected of ovarian cancer. During the course of the study increased awareness of health system intervals results in a reduction in treatment delays.
Surgery forms the cornerstone of treatment for patients with endometrial cancer. Clinical decisions regarding the extent of surgery are based on a risk stratification of pre-operatively obtained endometrial tissue. Our data show that in 90% of patients the pre-operative risk stratification is concordant with the post-operative risk stratification. Currently, only the post-operatively obtained tissue is used to guide decisions regarding adjuvant therapy while our data suggested that the pre-operative risk stratification contains independent prognostic information. Within the Netherlands 85% of patients are treated according to adjuvant therapy guidelines but there are large variations in clinical practise in high risk patients.
To improve optimalization of care for patients with endometrial cancer, we performed an immunological profile of endometrial cancer tumors. Our data suggested that patients with POLE-mutant and microsatellite instability could benefit from immune checkpoint inhibition therapy.