Is there any value in the long term follow up of women treated for endometrial cancer?

Allsop, J. R.; Preston, J.; Crocker, Simon G.

doi:10.1111/j.1471-0528.1997.tb10672.x

Cited by 22 publications

(26 citation statements)

References 3 publications

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“…A detection of each asymptomatic vaginal recurrence requires 1067 Pap-smear tests, producing benefits for only 0.5% of patients 9. Neither recurrence free nor the overall survival are improved in these cases compared to those detected at clinical presentation 10,11. Only in non-irradiated patients, a strong case can be made for regular follow-up to detect vaginal recurrence at the earliest opportunity, given the high salvage rate following radiotherapy 12,13.…”

Section: Discussionmentioning

confidence: 99%

What sampling device is the most appropriate for vaginal vault cytology in gynaecological cancer follow up?

Pup¹,

Canzonieri²,

Serraino³

et al. 2012

Radiology and Oncology

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BackgroundIn women with cancer-related hysterectomy, the vaginal vault cytology has a low efficacy - when performed by conventional methods – for the early detection of vaginal recurrence. The amount of exfoliated cells collected is generally low because of atrophy, and the vaginal vault corners can be so narrow that the commonly used Ayres spatula cannot often penetrate deeply into them. This prospective study aimed at identifying the advantages obtained in specimens collection using the cytobrush, as compared to the Ayres’s spatula.Patients and methods.141 gynaecologic cancer patients were studied to compare samplings collected with Ayre’s spatula or with cytobrush. In a pilot setting of 15 patients, vaginal cytology samples obtained by both Ayre’s spatula and cytobrush were placed at the opposite sites of a single slide for quali-quantitative evaluation. Thereafter, the remaining 126 consecutive women were assigned to either group A (spatula) or B (cytobrush) according to the order of entry. The same gynaecologist performed all the procedures.ResultsIn all 15 pilot cases, the cytobrush seemed to collect a higher quantity of material. The comparative analysis of the two complete groups indicated that the cytobrush technique was more effective than the spatula one. The odds ratio (OR) for an optimal cytology using the cytobrush was 2.8 (95% confidence interval -C.I. 1.3–6.2; chi-square test, p=0.008).ConclusionsVaginal vault cytology with cytobrush turned out to better perform than the traditional Ayre’s spatula to obtain an adequate sampling in gynecological cancer patients.

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Section: Discussionmentioning

confidence: 99%

What sampling device is the most appropriate for vaginal vault cytology in gynaecological cancer follow up?

Pup¹,

Canzonieri²,

Serraino³

et al. 2012

Radiology and Oncology

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“…Although the numbers were too small for statistical significance, there are no published data on survival benefits of early detection with routine follow up. Studies of follow up in endometrial cancer have also shown the ineffectiveness of follow up as well as lack of good evidence that detection of recurrences at a routine follow up clinic changes the prognosis of the disease 9–12 …”

Section: Discussionmentioning

confidence: 99%

“…It is clear from studies on the follow up of patients with endometrial cancer that there is little evidence that follow up is associated with better survival 9–12 . Furthermore, there have been other studies showing no long term difference in survival rates after recurrence between patients whose recurrences were detected routinely and those who initiated their visits when they were symptomatic 12 .…”

Section: Introductionmentioning

confidence: 99%

The role of clinical follow up in early stage cervical cancer in South Wales

Lim

Howells

Evans

2004

BJOG

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Objective To assess the effectiveness of clinical follow up after primary surgery for early stage cervical cancer. Design Retrospective analysis of clinical follow up after radical hysterectomy and node dissection for early stage cervical cancer. Setting Gynaecological Oncology Cancer Centre.Sample Two hundred and ninety-one patients who underwent surgery for cervical cancer.Methods Follow up data were collected retrospectively from hand-searched patients notes, as well as a computerised database (Information System for Clinical Organisation [ISCO]). The data were analysed using the SPSS for windows (SPSS, Chicago, Illinois) statistics package, using m 2 , Kaplan -Meier life tables and Cox Linear regression analysis. Main outcome measures To determine whether routine follow up was useful for detecting early recurrent disease. Results Two hundred and ninety-one patients treated by radical hysterectomy and node dissections were followed up. The cumulative five-year survival for all cases in our series was 80% and 53/291 patients (18.2%) were found to have recurrent disease. The median period from surgery to recurrence was 17.6 months (3.0 -60.0). Seven patients with recurrence were detected at a routine follow up examination, and two out of seven of the patients were asymptomatic. Detection of the recurrence on routine follow up was not an independent prognostic factor for survival when compared with age, stage and whether the patient received post-operative adjuvant therapy. Conclusions Routine follow up in patients following radical hysterectomy and node dissection for early stage cervical cancer is not a sensitive way of detecting recurrent disease, as a high proportion of patients were symptomatic at the time of detection. As there are other reasons for follow up, we propose alternative methods of structuring the programme.

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“…A review of the routine follow-up management of patients after treatment for EC identified 11 studies [258][259][260][261][262][263][264][265][266][267][268] from a range of countries, including one study from England 263 and one from Scotland, 262 covering the period 1977-97. 269 The management was designed to identify recurrence of EC and included clinical examination, smear of the vaginal vault, chest X-ray, ultrasound and CT scans, although the study from England reported only occasional clinical examinations and the study from Scotland only occasional clinical examinations and occasional smear.…”

Section: Cost Of Follow-up Management Of Endometrial Cancermentioning

confidence: 99%

A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

Snowsill

Huxley

Hoyle

et al. 2014

Health Technology Assessment

108

234

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BackgroundLynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes.ObjectiveTo evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged < 50 years). Cascade testing of relatives is employed in all strategies for individuals in whom LS is identified.Data sources and methodsSystematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed.ResultsInconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing.The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI andBRAFtesting [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the population of interest would be obtained using universal germline testing, but this would not be a cost-effective use of NHS resources compared with the next best strategy. When the age limit was raised from 50 to 60 and 70 years, the ICERs compared with no testing increased but remained below £20,000 per QALY (except for universal germline testing with an age limit of 70 years). The total net health benefit increased with the age limit as more individuals with LS were identified. Uncertainty was evaluated through univariate sensitivity analyses, which suggested that the parameters substantially affecting cost-effectiveness: were the risk of CRC for individuals with LS; the average number of relatives identified per index patient; the effectiveness of colonoscopy in preventing metachronous CRC; the cost of colonoscopy; the duration of the psychological impact of genetic testing on health-related quality of life (HRQoL); and the impact of prophylactic hysterectomy and bilateral salpingo-oophorectomy on HRQoL (this had the potential to make all testing strategies more expensive and less effective than no testing).LimitationsThe absence of high-quality data for the impact of prophylactic gynaecological surgery and the psychological impact of genetic testing on HRQoL is an acknowledged limitation.ConclusionsResults suggest that reflex testing for LS in newly diagnosed CRC patients aged < 50 years is cost-effective. Such testing may also be cost-effective in newly diagnosed CRC patients aged < 60 or < 70 years. Results are subject to uncertainty due to a number of parameters, for some of which good estimates were not identified. We recommend future research to estimate the cost-effectiveness of testing for LS in individuals with newly diagnosed endometrial or ovarian cancer, and the inclusion of aspirin chemoprevention. Further research is required to accurately estimate the impact of interventions on HRQoL.Study registrationThis study is registered as PROSPERO CRD42012002436.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Is there any value in the long term follow up of women treated for endometrial cancer?

Cited by 22 publications

References 3 publications

What sampling device is the most appropriate for vaginal vault cytology in gynaecological cancer follow up?

What sampling device is the most appropriate for vaginal vault cytology in gynaecological cancer follow up?

The role of clinical follow up in early stage cervical cancer in South Wales

A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

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