Holistic Integrated Care in Ovarian Cancer (HICO)—reducing inequalities due to age, frailty, poor physical and mental health
Older patients have disproportionally poorer survival outcomes for ovarian cancer in the UK. Half of new diagnoses occur in those aged >65 years. Older patients are more likely to have other medical comorbidities reducing their fitness to receive chemotherapy or undergo cytoreductive surgery resulting in fewer patients receiving treatment. The Holistic Integrated Care in Ovarian Cancer (HICO) programme introduced a structured holistic patient assessment with both universal and targeted interventions to improve physical function and psychological well-being to reduce inequalities due to age, frailty, physical and psychosocial problems. The aim of the project was to evaluate the feasibility and impact of the intervention in patients being considered for the treatment of ovarian cancer. During the implementation of the project, all recruited patients underwent a holistic assessment followed by prehabilitation and rehabilitation support from physiotherapists, occupational therapists, dietitians, geriatricians, nurse specialists and psychologists according to need. The HICO intervention was successfully integrated into the patient pathway in both trusts. Patients who participated in the HICO project provided positive feedback. Overall global health scores improved in 59.6% of the 57 patients who undertook at least two assessments (p=0.006). The proportion of patients who underwent platinum doublet chemotherapy in the HICO cohort was higher (76.2%) compared with a retrospective cohort (57.6%) (p=0.0189). However, no significant difference in the rate of cytoreductive surgery was shown. The proportion of patients alive at 1 year from diagnosis was higher in the HICO intervention group (88.9%) compared with the historical cohort (80.0%) despite higher stage in the HICO group. Although not statistically significant (p=0.289), these data are not yet mature and further study is ongoing. Initial data on costs of ovarian cancer care demonstrated no increase, although the data are not yet mature. This pilot project was funded through the Ovarian Cancer Action IMPROVE UK Pilot Award scheme.
