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. 2011 Jun 15:(6):CD006119.
doi: 10.1002/14651858.CD006119.pub2.

Evaluation of follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment

Fiona Kew  1 , Khadra Galaal, Andrew Bryant, Raj Naik
Affiliations

Evaluation of follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment

Fiona Kew et al. Cochrane Database Syst Rev. .

Update in

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.

Objectives: To compare the potential benefits of different strategies of follow up in women with epithelial ovarian cancer following completion of primary treatment.

Search strategy: 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.

Selection criteria: All relevant randomised controlled trials (RCTs) that evaluated follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment.

Data collection and analysis: Two review authors independently abstracted data and assessed risk of bias.

Main 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.

Authors' 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.

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Figures

Figure 1
Figure 1
Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

References

References to studies included in this review

    1. Rustin GJ, van der Burg ME, Griffin CL, Guthrie D, Lamont A, Jayson GC, et al. on behalf of MRC and EORTC collaborators Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial. Lancet. 2010;376(9747):1155–63. - PubMed

References to studies excluded from this review

    1. Chan KKL, Tam KF, Tse KY, Ngan HYS. The role of regular physical examination in the detection of ovarian cancer recurrence. Gynecologic Oncology. 2008;110(2):158–61. - PubMed
    1. Gadducci A, Cosio S, Zola P, Landoni F, Maggino T, Sartori E. Surveillance procedures for patients treated for epithelial ovarian cancer: a review of the literature. International Journal of Cancer. 2007;17(1):21–31. - PubMed
    1. Goonewardene TI, Hall MR, Rustin GJS. Management of asymptomatic patients on follow-up for ovarian cancer with rising CA-125 concentrations. Lancet Oncology. 2007;8(9):813–21. - PubMed
    1. Maggino T, Ronsisvalle O, Tredese F, Valente S, Brandes A, Onnis GL, et al. Role of computed abdominal tomography CAT scan in the follow up of ovarian tumors. European Journal of Gynaecological Oncology. 1983;4(1):47–9. - PubMed
    1. Olaitan A, Murdoch J, Anderson R, James J, Graham J, Barley V. A critical evaluation of current protocols for the follow-up of women treated for gynecological malignancies: a pilot study. International Journal of Gynecological Cancer. 2001;11(5):349–53. - PubMed

References to ongoing studies

    1. Lanceley A. A randomised study comparing satisfaction with follow up led by a trained cancer nurse versus conventional medical follow-up after primary treatment for ovarian cancer. N0263172828. [: ISRCTN59149551 ]

Additional references

    1. Aebi S, Castiglione M. Epithelial ovarian carcinoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Annals of Oncology. 2008;19(Suppl 2):14–6. - PubMed
    1. Barnhill D, O’Connor D, Farley J, Teneriello M, Armstrong D, Park R. Clinical surveillance of gynecologic cancer patients. Gynecological Oncology. 1992;46(3):275–80. - PubMed
    1. Barzen G, Cordes M, Langer M, Friedman W, Mayr AC, Felix R. Value of radioimmunoscintigraphy compared to computed tomography in the diagnosis and follow-up of primary ovarian carcinoma. RöFo: Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin. 1990;153(1):85–91. - PubMed
    1. Bradley E, Pitts M, Redman C, Calvert E, Howells R, Wafai C. What are the factors associated with the follow-up preferences of women in long-term remission from gynaecological cancer? Journal of Obstetrics and Gynaecology. 2000;20(4):408–11. - PubMed
    1. Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecologic Oncology. 2009;112(1):265–74. - PubMed

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