Patients' views of follow-up after treatment for gynaecological cancer.

This project set out to quantify women's views of routine follow-up. Women attending for routine follow-up after gynaecological cancer completed a questionnaire. A total of 54% (48/89) reported increased anxiety prior to their appointment, and 10% (9/90) still felt more anxious afterwards. Most women (82/92, 89%) preferred to see a hospital doctor, and preferred this to a review by a specialist nurse or general practitioner (p<0.001). Women thought the examination was the most important part of the visit (p<0.0001). Women viewed the specialist nurse's role as listening to concerns and taking blood, rather than detecting recurrence (p<0.0001). Women ranked detection of recurrence as the most important reason for attending for follow-up (p<0.0001). Overall, women think that detection of recurrence is the primary rationale for routine follow-up. Their views need to be taken into consideration when considering changes in the provision of follow-up care.

Evaluation of prognostic factors and treatment outcomes in uterine carcinosarcoma.

OBJECTIVE: The aims of this study were to determine the prognostic factors, survival outcomes and response to adjuvant therapy in women with uterine carcinosarcoma treated in a single institution. STUDY DESIGN: This is a cohort study of women diagnosed with carcinosarcoma and treated at the Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK. The medical records of all patients diagnosed with carcinosarcoma between January 1960 and July 2002 were reviewed. RESULTS: A total of 93 women were identified during this period. The median age was 67 years. The most common presentation was abnormal vaginal bleeding, occurring in 85%, followed by pelvic mass in 45%, and abdominal pain in 38%. At surgery there was extra-uterine spread in 54% of women. The median follow-up was 33 months (range 4-146 months). Adjuvant therapy was not associated with survival advantage. Recurrence was diagnosed in 55 patients (59%) and the overall 5-year survival for all stages was 33%. On multivariate analysis depth of myometrial invasion, stage and pelvic nodes metastasis were associated with poor survival. CONCLUSION: The poor outcome for these patients may reflect the aggressive nature of carcinosarcoma and that at the time of presentation more than 50% have extra-uterine disease, which was associated with significant poorer survival. Systemic adjuvant therapy has not been associated with significant improvement in the outcome. More studies are needed to better define the appropriate treatment for this rare cancer.

Professionals' and patients' views of routine follow-up: a questionnaire survey.

Traditionally, women who have been treated for a gynecological cancer have undergone long-term follow-up by hospital doctors. Recently, there has been interest in alternative models of follow-up, including nurse-based review. The project compares patients' and professionals' views of follow-up. A questionnaire was completed by 96 women attending routine follow-up clinics and by 32 professionals involved in delivering follow-up. A large majority of women (82/96, 92%) and professionals (25/34, 73%) thought that follow-up should be provided by a hospital doctor. However, professionals were more likely to think that specialist nurses and general practitioners should be involved in the provision of follow-up (P < 0.01). Professionals thought that the most important part of the follow-up visit was the consultation, whereas women thought it was the examination (P < 0.001). Women thought that detection of recurrence was the most important reason for continuing surveillance, whereas professionals regarded addressing patients' concerns as the primary reason for follow-up (P < 0.001). We conclude that the views of women undergoing follow-up after gynecological cancer differ significantly from the professionals providing follow-up care. These views must be considered when developing alternative follow-up strategies.

The effect of epithelial and stromal tumor components on FIGO stages III and IV ovarian carcinosarcomas treated with primary surgery and chemotherapy.

The aim of this study is to assess the effect of epithelial and stromal tumor components on survival outcomes in FIGO stage III or IV ovarian carcinosarcomas (OCS) treated with primary surgery and adjuvant chemotherapy at the Northern Gynaecological Oncology Centre (NGOC), Gateshead. Women were identified from the histopathology/NGOC databases. Age, FIGO stage, details of histology, treatment, and overall survival were recorded. Of 34 cases (1994-2006, all FIGO stages), 17 were treated with primary surgery followed by adjuvant chemotherapy for FIGO stage III or IV. The median age was 66 years (52-85 years). Cytoreduction was optimal (n= 9) or complete (n= 1) in 10/17 (59%) cases. Epithelial predominant (EP) or stromal predominant (SP) tumor (defined as >50% of either component in the primary tumor) was noted in 12 and 5 cases, respectively. Epithelial types included serous (n= 9), endometrioid (n= 5), and mixed types (n= 3). Twelve women have died of disease. The median overall survival was 11.0 months (3-74 months). On univariate analysis, survival was not affected by optimal/suboptimal debulking, platinum/doxorubicin-containing chemotherapy, or homologous/heterologous stromal components. Stromal components (>25%) adversely affected survival (P= 0.02), and there was a trend to worse survival with serous compared with nonserous epithelial components (P= 0.07). Cox regression (multivariate analysis) showed that SP tumors (P= 0.04), suboptimal debulking (P= 0.01), age (P= 0.01), and tumors with serous epithelial component (P= 0.05) were adverse independent prognostic factors. Type of chemotherapy and homologous/heterologous components (P= 0.24) did not affect overall survival. In conclusion, our study suggests that SP-OCS have a worse survival outcome than EP tumors. Tumors with serous epithelial components adversely affected the survival compared with nonserous components. Larger studies are required to confirm these effects and to identify the optimum chemotherapy regimen for OCS.

Routine follow-up after treatment for a gynecological cancer: a survey of practice.

The objective of this study was to determine current practice with regards to follow-up after gynecological malignancy. A questionnaire survey of all lead clinicians in gynecological cancer centers in England was done. The most common duration of routine follow-up was 5 years for all of the main gynecological cancers (ovarian, endometrial, vulval, and cervical). The most common follow-up patterns were three monthly for 2 years then six monthly for 3 years after ovarian cancer; three monthly for the first year, four monthly for the second year, six monthly for the third year then annually for 1 year after endometrial cancer; three monthly for the first year, four monthly for the second year, six monthly for the third and fourth years, then annually for 1 year after vulval cancer; three monthly for the first year, four monthly for the second year, six monthly for the third and fourth years, then annually for 1 year after cervical cancer. The test for CA125 was routinely performed by 67% of cancer networks to detect recurrence after ovarian cancer. Routine follow-up after gynecological cancer continues to be standard practice, despite limited evidence to support its use. Prospective research is needed to determine best practice.

The role of routine follow-up after gynecological malignancy.

The objective of this article was to determine the evidence base for routine follow-up after gynecological malignancy. Only articles with a survival analysis were included. Relevant articles were identified by a comprehensive literature search of the main biomedical databases, hand searching of references of selected articles, and expert spotting of relevant journals and proceedings of international meetings. A two-stage extraction of data was undertaken. No prospective trials were identified. Twenty-nine retrospective case series analyses and one poster presentation met the inclusion criteria. Eight articles and one letter on endometrial cancer, six articles and one poster presentation on cervical cancer, and two articles in vulval cancer were reviewed. Only one article in endometrial cancer showed any survival benefit from routine follow-up, but it was of very poor methodologic quality. Two articles found a survival benefit from routine follow-up after cervical cancer. The two articles on vulval cancer did not find any survival benefit from routine review. There is no prospective research on the benefits of routine follow-up after gynecological cancer. Retrospective evidence calls in to question the benefit of universal follow-up. Prospective research is urgently needed.

Preconceptions versus experience of transvaginal ultrasonography in older women.

OBJECTIVE: To determine whether women find that having a transvaginal ultrasound scan is better or worse than they had expected. METHODS: Fifty-four consecutive women in an ovarian cancer screening trial filled in linked questionnaires before and after having a transvaginal ultrasound scan. RESULTS: The women found that having a transvaginal scan was less painful (P = 0.003) and less embarrassing (P = 0.001) than they had expected. They found it less uncomfortable than expected in comparison to having mammography (P = 0.013) or a cervical smear (P = 0.004). CONCLUSIONS: Women attending for a transvaginal scan can be reassured that it will not be as painful or embarrassing as they fear, and that it is not as uncomfortable as having mammography or a cervical smear.

Tolerability of transvaginal ultrasonography as an ovarian cancer screening test.

OBJECTIVE: To evaluate the acceptability of transvaginal ultrasonography as a screening tool. DESIGN: Prospective survey of women attending for screening within a randomised controlled trial. SETTING: University Hospital in Teesside. PARTICIPANTS AND METHODS: 54 women completed a questionnaire immediately after their first transvaginal ultrasound scan. RESULTS: 52 of 54 (96%) questionnaires were suitable for full analysis. The women were unlikely to find the scan was painful, 47 vs three (p<0.001), or embarrassing 45 vs five (p<0.001). Women were more likely to find both a smear, 42 vs eight (p<0.001) and a mammogram, 47 vs two (p<0.001) was more uncomfortable than transvaginal ultrasonography. CONCLUSIONS: Transvaginal ultrasonography is an acceptable tool for screening for ovarian cancer. It is better tolerated than other screening tools such as cervical smear and mammography.