Right Place, Right Time: The Impact of Referral Accuracy on the Wellbeing of Women with Ovarian Tumours: an observational cohort study

Introduction The pre-operative classification of ovarian tumors remains challenging due to the inherent limitations in the diagnostic accuracy of current risk-assessment strategies, leading to both false-negative non-referrals and false-positive referrals. This study aimed to assess how (in)correct referrals affect quality of life (QoL) in women undergoing surgery for an ovarian tumour. Methods A prospective multicentre cohort study was conducted and 571 consecutive women with an ovarian tumour with indication for surgery were prospectively enrolled in 28 Dutch non-oncology centres. QoL was measured using the EQ-5D-5L at surgical decision-making, preoperatively, and at six weeks and three months postoperatively. Patients were categorized as true negative, false positive, false negative, or true positive based on referral status and histopathology. Results Among 571 women, 75.0% had surgery in a non-oncological centre; final histopathology showed 66.2% benign, 17.5% borderline and 16.3% malignant tumours. QoL prior to surgery did not differ significantly between patients with benign tumours (true-negative and false-positive groups: 0.785 ± 0.183 vs 0.778 ± 0.196), or those with malignant tumours (false-negative and true-positive groups: 0.715 ± 0.244 vs 0.734 ± 0.178), p>0.05 for both comparisons. Overall, patients reported lower preoperative QoL compared with age-matched population means. Three months postoperatively, women with benign tumours who were referred to an oncology centre reported higher QoL than those who were not referred (0.937 ± 0.081 vs 0.889 ± 0.151, p<0.05). Women with malignant tumours who were not referred to an oncology centre reported the lowest QoL, although the difference with the referred group was not statistically significant. Discussion Women undergoing surgery for an ovarian tumor experience diminished QoL relative to the general population, with the lowest QoL observed among women with malignant tumors who were not referred preoperatively. These findings underscore the potential value of highly sensitive preoperative risk assessment strategies to reduce false-negative non-referrals.