title: Variation in gynecological oncology follow-up practice: attributable to cancer centers or to patient characteristics? A Piedmont Regional Oncology Network Study.
abstract: OBJECTIVE
  Although guidelines recommend minimalist follow-up, there is wide variability in gynecological oncology practice. The aims of this study were to describe between-center differences in the follow-up of endometrial, ovarian, and uterine cervical cancer; to identify the determinants of test prescription; to estimate the related costs; and to assess the weight of center habits and patient characteristics as sources of unexplained variability.
  
  
  METHODS
  The medical records of patients treated between August 2004 and July 2005 for gynecological malignancies and followed up for the detection of recurrent disease were retrospectively collected from 29 centers of the Piedmont Oncology Network. Multivariate multilevel analyses were performed to study the determinants of test prescription and costs.
  
  
  RESULTS
  Analyses were performed on 351 patients (median follow-up: 578 days). The unexplained variability in computed tomography prescriptions (26%), ultrasound prescriptions (17%), and total cost of follow-up (15%) can be attributed to center habits, independenty of the clinical characteristics of the patients.
  
  
  CONCLUSIONS
  Much of the unexplained variability in the follow-up for gynecological malignancies is attributable to different habits of centers belonging to a cancer network. These results prompted us to design a multicenter randomized controlled trial to compare minimalist versus intensive follow-up programs in endometrial cancer.
authors.affiliation: Gynecology and Obstetrics Academic Department, Azienda Ospedaliera Ordine Mauriziano, Turin. luca.fuso@fastwebnet.it
authors.forename: Luca
authors.initials: L
authors.lastname: Fuso
authors.forename: Andrea
authors.initials: A
authors.lastname: Evangelista
authors.forename: Eva
authors.initials: E
authors.lastname: Pagano
authors.forename: Elisa
authors.initials: E
authors.lastname: Piovano
authors.forename: Stefania
authors.initials: S
authors.lastname: Perotto
authors.forename: Simona
authors.initials: S
authors.lastname: Mazzola
authors.forename: Emiliana
authors.initials: E
authors.lastname: Bertoldo
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: La Porta
authors.forename: Claudia
authors.initials: C
authors.lastname: Rosmino
authors.forename: Graziella
authors.initials: G
authors.lastname: Furbatto
authors.forename: Sergio
authors.initials: S
authors.lastname: Abate
authors.forename: Gianna
authors.initials: G
authors.lastname: Di Costanzo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Trossarelli
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Baù
authors.forename: Flavio
authors.initials: F
authors.lastname: Carnino
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Gambaro
authors.forename: Paola
authors.initials: P
authors.lastname: Piantanida
authors.forename: Oscar
authors.initials: O
authors.lastname: Alabiso
authors.forename: Luciano
authors.initials: L
authors.lastname: Galletto
authors.forename: Laura
authors.initials: L
authors.lastname: Zavallone
authors.forename: Annalisa
authors.initials: A
authors.lastname: Rossi
authors.forename: Maggiorino
authors.initials: M
authors.lastname: Barbero
authors.forename: Maria
authors.initials: M
authors.lastname: Tessa
authors.forename: Dionyssios
authors.initials: D
authors.lastname: Katsaros
authors.forename: Saverio
authors.initials: S
authors.lastname: Danese
authors.forename: Paola
authors.initials: P
authors.lastname: Brignolo
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gorzegno
authors.forename: Raffaella
authors.initials: R
authors.lastname: Grillo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Apolone
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities / Q000592:standards / Q000706:statistics & numerical data*; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000191:economics; D016889:Endometrial Neoplasms; D005260:Female; D005833:Genital Neoplasms, Female / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D017048:Health Care Costs; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control