title: Follow-up protocols for women with cervical cancer after primary treatment.
abstract: BACKGROUND
  Cervical cancer is the second most common cancer among women up to 65 years of age and is the most frequent cause of death from gynaecological cancers worldwide. Although surveillance of women after completion of primary treatment for cervical cancer is purported to have an impact on their overall survival (OS), no strictly defined follow-up protocols are available for these women. Wide diversity in management has been noted in the follow-up of women who have completed primary treatment for cervical cancer. Traditionally, women treated for cervical cancer undergo routine long-term, even life-long, follow-up. The primary objective of this practice has been to detect and treat recurrence early. This review sets out to systematically evaluate available evidence for the role of different models of follow-up after cervical cancer and the optimal use of investigations.
  
  
  OBJECTIVE
  To evaluate the benefits, harms and costs of different follow-up protocols for women who have completed primary treatment for cervical cancer.
  
  
  METHODS
  We searched CENTRAL (The Cochrane Library 2013, Issue 1), the Cochrane Gynaecological Cancer Group (CGCG) Trials Register, MEDLINE and EMBASE up to January 2013. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of clinical guidelines and review articles and contacted experts in the field.
  
  
  METHODS
  We searched for randomised controlled trials (RCTs) that compared different follow-up protocols after primary treatment in women with cervical cancer.
  
  
  METHODS
  Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. No trials were found, and therefore no data were analysed.
  
  
  RESULTS
  The search strategy identified 1,377 unique references, of which all were excluded on the basis of title and abstract.
  
  
  CONCLUSIONS
  We found no evidence to inform decisions about different follow-up protocols after primary treatment for women with cervical cancer. Ideally, a large RCT or, at the very least, well-designed non-randomised studies (NRSs) that use multi-variate analysis to adjust for baseline imbalances are needed to compare these follow-up protocols. Such studies could include prospective trials conducted to determine the benefits and harms of different follow-up protocols upon completion of primary treatment for cervical cancer, along with an RCT undertaken to compare predefined follow-up protocols versus participant-initiated follow-up versus no follow-up until a participant is referred to a gynaecological oncology service after signs or symptoms of recurrence have been identified in the primary care or community setting.
authors.affiliation: Department of Women's Cancer, The UCL Elizabeth Garrett Anderson Institute for Women's Health, Medical School Building, 74 Huntley St, London, UK, WC1E 6AU.
authors.forename: Anne
authors.initials: A
authors.lastname: Lanceley
authors.forename: Alison
authors.initials: A
authors.lastname: Fiander
authors.forename: Mary
authors.initials: M
authors.lastname: McCormack
authors.forename: Andrew
authors.initials: A
authors.lastname: Bryant
mesh_terms: D000328:Adult; D000359:Aftercare; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002583:Uterine Cervical Neoplasms / Q000628:therapy*