Gynaecological cancer follow-up: national survey of current practice in the UK

Abstract

ObjectiveTo establish a baseline of national practice for follow-up after treatment for gynaecological cancer.DesignQuestionnaire survey.SettingGynaecological cancer centres and units.Geographical locationUK.ParticipantsMembers of the British Gynaecological Cancer Society and the National Forum of Gynaecological Oncology Nurses.InterventionsA questionnaire survey.Outcome measuresTo determine schedules of follow-up, who provides it and what routine testing is used for patients who have had previous gynaecological cancer.ResultsA total of 117 responses were obtained; 115 (98%) reported hospital scheduled regular follow-up appointments. Two involved general practitioners. Follow-up was augmented or replaced by telephone follow-up in 29 responses (25%) and patient-initiated appointments in 38 responses (32%). A total of 80 (68%) cancer specialists also offered combined follow-up clinics with other specialties. Clinical examinations for hospital-based follow-up were mainly performed by doctors (67% for scheduled regular appointments and 63% for patient-initiated appointments) while telephone follow-up was provided in the majority by nurses (76%). Most respondents (76/117 (65%)) provided routine tests, of which 66/76 (87%) reported carrying out surveillance tests for ovarian cancer, 35/76 (46%) for cervical cancer, 8/76 (11%) for vulval cancer and 7/76 (9%) for endometrial cancer. Patients were usually discharged after 5 years (82/117 (70%)), whereas three (3%) were discharged after 4 years, nine (8%) after three years and one (1%) after 2 years.ConclusionsPractice varied but most used a standard hospital-based protocol of appointments for 5 years and routine tests were performed usually for women with ovarian cancer. A minority utilised nurse-led or telephone follow-up. General practitioners were rarely involved in routine care. A randomised study comparing various models of follow-up could be considered.

Late Recurrence of Early Stage Cervical Cancer more than 3 Years after Radical Hysterectomy with Pelvic Node Dissection

“…In addition, Hiyoshi et al [24] found that lymph node metastasis at radical surgery was a risk factor for late recurrence of esophageal cancer. In many institutes cervical cancer patients who are tumor free 5 years after diagnosis are considered discharged from follow-up [6,29]. However, our results suggest that regular follow-up assessments in early stage cervical cancer should be continued until at least 8.6 years of tumor-free survival, especially in patients with lymph node metastasis and/or DSI at RHND.…”

Trial of Optimal Personalised Care After Treatment—Gynaecological Cancer (TOPCAT-G)

“…The Society of Gynecologic Oncology recommends that there is a need for prospective research including cost-effectiveness calculations to help determine ideal follow-up care. 4 The most common practice is for the clinician to review a patient on a regular basis, in a hospital-based, outpatient clinic over a number of years, 5 with the aim of checking for local recurrence or distant metastasis. 6 However, there is no prospective evidence that the traditional method of follow-up identifies recurrences earlier or improves overall survival because most recurrences are symptomatic.…”

The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials

“…The most common duration of routine follow-up is for at least five years [2,9]. The reported aim of regular follow-up is to allow detection of recurrent disease before symptoms develop, allowing earlier treatment with a possible improved outcome, as well as providing an opportunity to provide information and signal early and late consequences of treatment.…”

“…For gynaecological cancers, follow-up is mainly delivered by doctors in secondary care [9] and there is very little quality evidence to inform guideline developers in relation to gynaecological oncology follow-up [17]. Eighty per cent of all gynaecological cancer recurrences generally occur in the first two years after treatment [18] and follow-up visits are more frequent during this time.…”