The feasibility of risk-based triage for ovarian cancer using age-specific thresholds: a qualitative interview study with general practitioners

Most women diagnosed with ovarian cancer in the UK have advanced disease, when it’s difficult to treat. Finding ways to diagnose cancer early could save lives. When women visit their GP with ovarian cancer symptoms, they may get a blood test called CA125. If the result is high (above 35), they may be offered an ultrasound. CA125 is a good test for ovarian cancer among older women, but it is less accurate for younger women. We developed a mathematical model called ‘Ovatools’ to predict their chance of having ovarian cancer using the CA125 test result and age, and it was more accurate than using the CA125 test alone. Ovatools could inform patients’ and GPs’ decisions for further testing based on their chance of ovarian cancer and how quickly. For instance, if their chance of cancer is 1-2.9%, they could be offered an ultrasound, or if their chance is 3% or more, they could be fast-tracked to a cancer specialist. Benefits of this approach are more people can be diagnosed with cancer early and for those with a high chance of cancer (>3%), wait-times for a specialist could be shorter because they would have one test (CA125) instead of two (CA125 and ultrasound) before referral. Cancer can worsen quickly, so it’s important they don’t wait long for a diagnosis. This approach also means more women without cancer will be referred for additional tests or to a specialist and can be harmful due to anxiety around cancer and personal costs of extra healthcare visits.
For new methods like this to be used in the NHS, they must be tested to see if they could work in a real-life setting, and make sure the benefits outweigh harms. We also need to ensure that using Ovatools is feasible, especially given the pressures on the NHS and long wait-times for appointments. A key aspect of this is to find out if it’s acceptable to the people who will use
it (GPs) or those who might receive it (patients). In this study, we will interview GPs and ask about their thoughts of using this approach, how complicated the change seems, how they prefer to receive information when guideline changes are made, and what else might need to be addressed to ensure the new method can be used successfully. We will do interviews online, which will be recorded and transcribed into text. We will read the text to look for patterns and meaning in what GPs have shared. We will write about GPs perspectives, summarising whether they believe the approach is doable, what changes are needed to make it work, and how to communicate new information to all GPs and support them to use the new guidelines.

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Evidence synthesis working group
The collaboration will be conducting 18 high impact systematic reviews, under four workstreams.