The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials.
After completing treatment, most patients follow a pre-determined schedule of regular hospital outpatient appointments, which includes clinical examinations, consultations and routine tests. After several years of surveillance, patients are transferred back to primary care. However, there is limited evidence to support the effectiveness and efficiency of this approach. This paper examines the current rationale and evidence base for hospital-based follow-up after treatment for gynaecological cancer. We investigate what alternative models of care have been formally evaluated and what research is currently in progress in Europe, in order to make tentative recommendations for a model of follow-up. The evidence base for traditional hospital based follow-up is limited. Alternative models have been reported for other cancer types but there are few evaluations of alternative approaches for gynaecological cancers. We identified five ongoing European studies; four were focused on endometrial cancer patients and one feasibility study included all gynaecological cancers. Only one study had reached the reporting stage. Alternative models included nurse-led telephone follow-up and comparisons of more intensive versus less intensive regimes. Outcomes included survival, quality of life, psychological morbidity, patient satisfaction and cost effectiveness of service. More work is needed on alternative strategies for all gynaecological cancer types. New models will be likely to include risk stratification with early discharge from secondary care for early stage disease with fast track access to specialist services for suspected cancer recurrence or other problems.
Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Bangor, Gwynedd LL57 2PW UK. Electronic address: simon.leeson@wales.nhs.uk.
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Leeson
School of Health Sciences, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK.
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Beaver
Netherlands Comprehensive Cancer Organisation, Department of Research and Tilburg University, Department of Medical and Clinical Psychology, PO Box 231, 5600 AE, Eindhoven, The Netherlands.
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Ezendam
Latvian Oncology Center, Department of Gynecology, Riga Eastern Clinical University Hospital,Hippocrate Street 2, Riga, LV1038, Latvia.
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Mačuks
Director of Research & Innovation, Lancashire Teaching Hospitals NHS Trust, Preston, Lancashire PR2 9HT, UK.
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Martin-Hirsch
Royal United Hospital NHS Foundation Trust, Coombe Park, Bath BA1 3NG, UK.
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Miles
Department of Gynecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, 5000 Odense C, Denmark.
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Jeppesen
Department of Gynecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, 5000 Odense C, Denmark.
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Jensen
Department Surgical Sciences, University of Turin Italy, Via Ventimiglia 3, 10126 Turin, Italy.
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Zola
D000359:Aftercare / Q000191:economics / Q000592:standards*; D005260:Female; D005833:Genital Neoplasms, Female; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D016032:Randomized Controlled Trials as Topic
Female continuity of patient care/standards; Neoplasm; Neoplasm recurrence; Survivorship