title: Evaluation of follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment.
abstract: BACKGROUND
  Ovarian cancer is the sixth most common cancer and seventh cause of cancer death in women worldwide. Traditionally, many patients who have been treated for cancer undergo long-term follow up in secondary care. Recently however it has been suggested that the use of routine review may not be effective in improving survival, quality of life (QoL), and relieving anxiety. In addition, it may not be cost effective.
  
  
  OBJECTIVE
  To compare the potential benefits of different strategies of follow up in women with epithelial ovarian cancer following completion of primary treatment.
  
  
  METHODS
  We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010, Issue 4), MEDLINE and EMBASE (to November 2010). We also searched CINAHL, PsycLIT, registers of clinical trials, abstracts of scientific meetings, reference lists of review articles, and contacted experts in the field.
  
  
  METHODS
  All relevant randomised controlled trials (RCTs) that evaluated follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment.
  
  
  METHODS
  Two review authors independently abstracted data and assessed risk of bias.
  
  
  RESULTS
  We found only one RCT (Rustin 2010) that met our inclusion criteria. This trial included 529 women and reported data on immediate treatment versus delayed treatment in women with confirmation of remission and with normal CA125 concentration and no radiological evidence of disease after surgery and first-line chemotherapy.Overall survival showed no significant difference between the immediate and delayed arms after a median follow up of 56.9 months (unadjusted hazard ratio (HR) = 0·98, 95% confidence interval (CI) 0·80 to 1·20; P = 0·85). Time from randomisation to first deterioration in global health score or death was significantly shorter in the early group compared with the delayed group (HR 0·71, 95% CI 0·58 to 0·88; P < 0·01). The trial was at low risk of bias.
  
  
  CONCLUSIONS
  There is a lack of randomised studies on most aspects of follow-up care after treatment for epithelial ovarian cancers. Limited evidence from a single trial suggests that routine surveillance with CA125 in asymptomatic patients, with treatment at CA125 relapse, does not seem to offer survival advantage when compared to treatment at symptomatic relapse. Randomised controlled trials are needed to compare different types of follow up on the outcomes of survival, quality of Life, cost and psychological effects.
authors.affiliation: Gynaecological Oncology, Sheffield Teaching Hospitals, G18, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK, S10 2JF.
authors.forename: Fiona
authors.initials: F
authors.lastname: Kew
authors.forename: Khadra
authors.initials: K
authors.lastname: Galaal
authors.forename: Andrew
authors.initials: A
authors.lastname: Bryant
authors.forename: Raj
authors.initials: R
authors.lastname: Naik
mesh_terms: D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000628:therapy; D010051:Ovarian Neoplasms / Q000401:mortality / Q000628:therapy; D016032:Randomized Controlled Trials as Topic