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

After completing treatment, most patients follow a pre-determined schedule of regular hospital outpatient appointments, which includes clinical examinations, consultations and routine tests. After several years of surveillance, patients are transferred back to primary care. However, there is limited evidence to support the effectiveness and efficiency of this approach. This paper examines the current rationale and evidence base for hospital-based follow-up after treatment for gynaecological cancer. We investigate what alternative models of care have been formally evaluated and what research is currently in progress in Europe, in order to make tentative recommendations for a model of follow-up. The evidence base for traditional hospital based follow-up is limited. Alternative models have been reported for other cancer types but there are few evaluations of alternative approaches for gynaecological cancers. We identified five ongoing European studies; four were focused on endometrial cancer patients and one feasibility study included all gynaecological cancers. Only one study had reached the reporting stage. Alternative models included nurse-led telephone follow-up and comparisons of more intensive versus less intensive regimes. Outcomes included survival, quality of life, psychological morbidity, patient satisfaction and cost effectiveness of service. More work is needed on alternative strategies for all gynaecological cancer types. New models will be likely to include risk stratification with early discharge from secondary care for early stage disease with fast track access to specialist services for suspected cancer recurrence or other problems.

Comparison of different ovarian cancer detection algorithms.

UNLABELLED: The objective of the study was to evaluate the accuracy of a combined-two step ovarian cancer screening tool consisting of the ovarian cancer symptom index combined with either a risk of ovarian malignancy algorithm (ROMA) or a risk of malignancy index. MATERIAL AND METHODS: The case-control study consisted of 31 patients with ovarian cancer, 30 patients with benign ovarian diseases and 27 age-matched healthy controls. RESULTS: Sensitivity and specificity of the ovarian cancer symptom index among menopausal women were 84.6% and 52.9%, respectively. ROMA revealed the highest discriminative value when compared to others (AUC 98.4%). When the cutoff level of 28 was applied for menopausal women, ROMA revealed sensitivity and specificity of 95.8% and 93.1%, respectively. CONCLUSIONS: The ovarian cancer symptom index could be used as the first step in ovarian cancer screening with subsequent application of ROMA as a second step screening tool. A larger sample size in both control and patient groups should be evaluated to reach clear conclusions.

Diagnostic test for ovarian cancer composed of ovarian cancer symptom index, menopausal status and ovarian cancer antigen CA125.

UNLABELLED: The objective of the study was to evaluate accuracy of the diagnostic test composed of the ovarian cancer symptom index, ovarian cancer antigen CA125 and menopausal status. METHODS: A case-control study consisting of 75 women--24 patients with ovarian cancer, 20 patients with benign ovarian diseases, and 31 age-matched healthy controls. RESULTS: Sensitivity and specificity for the ovarian cancer symptom index alone was 83.3% and 48.3%, respectively. Specificity improved up to 70.9% when menopausal status was added. When CA125 (at cut-off level of 21 U/ml) was added to the ovarian cancer symptom index, the highest sensitivity and specificity was achieved resulting in 79.1% and 100.0%, respectively. CONCLUSIONS: The ovarian cancer symptom index could be used as a first-step screening tool in combination with serum biomarkers followed by TVS examination with an acceptable sensitivity and specificity. However, further prospective studies with larger sample size are needed to reach clear conclusions.