title: No supportive evidence for clinical benefit of routine follow-up in ovarian cancer: a Dutch multicenter study.
abstract: BACKGROUND
  Routine follow-up is standard medical practice in ovarian cancer patients treated with curative intent. However, no strong evidence exists indicating that prognosis is improved. The objective of this study was to evaluate the routine follow-up schedule for ovarian cancer patients regarding the adherence to the Dutch protocol, the detection of recurrences, and the follow-up's impact on overall survival.
  
  
  METHODS
  All 579 consecutive patients diagnosed with epithelial ovarian, primary peritoneal, or fallopian tube cancer in 4 Dutch hospitals between 1996 and 2006 were selected. Only patients in complete clinical remission after primary treatment were studied. Compliance to the Dutch follow-up guideline was assessed in a random sample of 68 patients. Of the 127 patients with recurrence, the mode of recurrence detection was addressed. Survival time since primary treatment was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  The patients received more follow-up visits than was recommended according to the guideline. The cumulative 5-year risk of recurrence was 55% (95% confidence interval [CI], 43%-67%). The survival of patients with recurrent ovarian cancer detected asymptomatically at a routine visit (n = 51) tended to be better compared with patients with symptomatic detection at a routine (n = 31) or diagnosed after an interval visit (n = 31). The median survival times were 44 (95% CI, 38-64), 29 (95% CI, 21-38), and 33 months (95% CI, 19-61), respectively (P = 0.08). The median time from primary treatment to recurrence was similar for the 3 groups: 14, 10, and 11 months, respectively (P = 0.26).
  
  
  CONCLUSIONS
  Follow-up in line with (inter)national guidelines yields a seemingly longer life expectancy if the recurrence was detected asymptomatically. However, this result is expected to be explained by differences in tumor biology and length-time bias.
authors.affiliation: Department of Epidemiology, Biostatistics, and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. S.Geurts@ebh.umcn.nl
authors.forename: Sandra M E
authors.initials: SM
authors.lastname: Geurts
authors.forename: Anne M
authors.initials: AM
authors.lastname: van Altena
authors.forename: Femmie
authors.initials: F
authors.lastname: de Vegt
authors.forename: Vivianne C G
authors.initials: VC
authors.lastname: Tjan-Heijnen
authors.forename: Leon F A G
authors.initials: LF
authors.lastname: Massuger
authors.forename: Jos A A M
authors.initials: JA
authors.lastname: van Dijck
authors.forename: André L M
authors.initials: AL
authors.lastname: Verbeek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000077216:Carcinoma, Ovarian Epithelial; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D055317:Evidence-Based Practice / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D009819:Office Visits / Q000706:statistics & numerical data; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D016019:Survival Analysis; D055815:Young Adult