The value of gynecologic cancer follow-up: evidence-based ignorance?
BACKGROUND
To explore the extent of evidence-based data and cost-utility of follow-up after primary treatment of endometrial and ovarian cancer, addressing perspectives of technology, organization, economics, and patients.


METHODS
Systematic literature searches according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions were conducted separately for each of the 4 perspectives. In addition, the organizational analysis included a nationwide questionnaire survey among all relevant hospital departments, and the operating costs were calculated.


RESULTS
None of the identified studies supported a survival benefit from hospital-based follow-up after completion of primary treatment of endometrial or ovarian cancer. The methods for follow-up were of low technology (gynecologic examination with or without ultrasound examination). Other technologies had poor sensitivity and specificity in detecting recurrence. Small changes in applied technologies and organization lead to substantial changes in costs. Substantial differences especially in frequency and applied methods were found between departments. The literature review did not find evidence that follow-up affects the women's quality of life.


CONCLUSIONS
The main purpose of follow-up after treatment of cancer is improved survival. Our review of the literature showed no evidence of a positive effect on survival in women followed up after primary treatment of endometrial or ovarian cancer. The conception of follow-up among physicians, patients, and their relatives therefore needs revision. Follow-up after treatment should have a clearly defined and evidence-based purpose. Based on the existing literature, this purpose should presently focus on other end points rather than early detection of relapse and improved survival. These end points could be quality of life, treatment toxicity, and economy.
Department of Gynecology and Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. lajer@dadlnet.dk
Henrik
H
Lajer
Mette B
MB
Jensen
Jannie
J
Kilsmark
Jens
J
Albæk
Danny
D
Svane
Mansoor R
MR
Mirza
Poul F
PF
Geertsen
Diana
D
Reerman
Kåre
K
Hansen
Maya C
MC
Milter
Ole
O
Mogensen
D002277:Carcinoma / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D055317:Evidence-Based Practice / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005843:Geography; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D019359:Knowledge; D009367:Neoplasm Staging; D012008:Recurrence; D016019:Survival Analysis