In seven health districts in southern England, an audit of the management of cervical cancer compared with regionally developed guidelines was undertaken between 1988 and 1991.
Four hundred and sixty-nine regional residents were treated in the study district hospitals. 73 (15.6%) women were appropriately staged, with increasing likelihood of appropriate staging investigations observed with higher stages (P<0.0001) and type of hospital [Teaching 23 (21%), Non-Teaching with oncology support 11 (11.5%), Non-teaching 4 (7%), P<0.0001] but with no change over the study period.
There was no significant trend in the proportion of women treated appropriately over time, with 270 (59%) being appropriately treated, 91 (20%) under-treated and 98 (21%) over-treated overall.
Appropriateness of treatment increased with higher stages (P<0.0001) and hospital workload for cancer of the cervix (P=0.038).
Multivariable analysis indicated that survival independently and significantly decreased with age and stage, under-treatment and in cases where lymph nodes were involved or not examined.
There was no change in the appropriateness of management over the 4 years, with high levels of inappropriate care.
Survival was not only influenced by biological and demographic factors, but by inappropriate care.
Mots-clés Pascal : Tumeur maligne, Col utérus, Incidence, Modalité traitement, Dépistage, Pronostic, Homme, Femelle, Epidémiologie, Echelon régional, Angleterre, Grande Bretagne, Royaume Uni, Europe, Appareil génital femelle pathologie, Col utérus pathologie
Mots-clés Pascal anglais : Malignant tumor, Uterine cervix, Incidence, Application method, Medical screening, Prognosis, Human, Female, Epidemiology, Regional scope, England, Great Britain, United Kingdom, Europe, Female genital diseases, Uterine cervix diseases
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0313928
Code Inist : 002B20C02. Création : 10/04/1997.