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Patel H, Drinkwater K, Stewart A. National Survey of Current Follow-up Protocols for Patients Treated for Endometrial Cancer in the UK. Clin Oncol (R Coll Radiol) 2024; 36:e146-e153. [PMID: 38548582 DOI: 10.1016/j.clon.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 12/12/2023] [Accepted: 03/08/2024] [Indexed: 05/06/2024]
Abstract
AIMS The aim of this study was to establish a baseline of national practice for follow-up after treatment for endometrial cancer in the UK. MATERIALS AND METHODS An online cross-sectional survey was developed and distributed through the Royal College of Radiologists via an email link to the audit leads of radiotherapy centres in the UK. The survey was conducted from November 2021 to 5 January 2022. The main themes assessed in the survey were the form, frequency and duration of follow-up practices. RESULTS There were a total of 43/61 (70%) complete responses. 93% of centres had a standard follow-up protocol and 7% who did not have a follow-up protocol discharged patients after the post-operative review. Five centres (13%) used molecular profiling to inform follow-up practices. Patient-initiated follow-up was mainly used in the cohort of patients who had surgery alone with no adjuvant treatment (68%, (19/28)). In the cohort who had face-to-face follow-up, the majority had pelvic examinations as part of their review and total follow-up for five years. 93% of respondents are interested in a national follow-up protocol. CONCLUSION Our data shows that there is national variation in practise with regard to follow-up of women treated for endometrial cancer. Many of the follow-up practises are based on conventional follow-up regimens and these may fail to address the more holistic needs of cancer survivors. Recent publication of updated guidance from the British Gynaecological Cancer Society may help standardise practise and provide a more relevant approach to follow-up for women treated for endometrial cancer.
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Affiliation(s)
- H Patel
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK.
| | | | - A Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; University of Surrey, Guildford, UK
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Mayer CM, O'Connor RM, Do AT, Cerda VR, Wang SM, Scott ME, Li AJ, Rimel BJ, Manuel MR, Taylor KN, Kim KH. Association between adherence to posttreatment National Comprehensive Cancer Network (NCCN) surveillance guidelines and detection of recurrent uterine cancer. Gynecol Oncol 2024; 181:8-11. [PMID: 38096674 DOI: 10.1016/j.ygyno.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To identify correlations between disease recurrence and adherence to NCCN posttreatment surveillance guidelines in patients who develop recurrent uterine cancer. METHODS Retrospective analysis identified patients (n = 60) with recurrent uterine cancer and at least one surveillance visit with a gynecologic oncologist between 2011 and 2020. Adherence to NCCN guidelines and details of recurrence were recorded. RESULTS Recurrent uterine cancer was identified in 60 patients with an average time to recurrence (TTR) of 25 months. Of those, 39 (65%) were adherent to NCCN surveillance guidelines and 36 (60%) were symptomatic at the time of recurrence diagnosis. Asymptomatic recurrence was diagnosed by imaging in 11 (46%), physical exam in 7 (29%), and blood work in 6 (25%) patients. Patients who were adherent to NCCN guidelines were diagnosed with recurrence on average 11 months earlier (p = 0.0336). Adherence was an independent predictor of TTR for all patients regardless of symptoms. There was no significant effect of age, race, primary language, or stage of disease on adherence. CONCLUSION Adherence to NCCN posttreatment surveillance guidelines for uterine cancer is independently associated with an earlier diagnosis of recurrence.
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Affiliation(s)
- Christopher M Mayer
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA.
| | - Reed M O'Connor
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Anthony T Do
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Victoria R Cerda
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Stephanie M Wang
- George Washington University, Department of Obstetrics & Gynecology, Washington, DC 20052, USA
| | - Marla E Scott
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Andrew J Li
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - B J Rimel
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Michael R Manuel
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Kristin N Taylor
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
| | - Kenneth H Kim
- Cedars-Sinai Medical Center, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Los Angeles, CA 90048, USA
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Barry P, Beriwal S, Maheshwari E, Bhargava R, Small W. Surveillance imaging for salvage therapy in endometrial cancer. Int J Gynecol Cancer 2023; 33:1464-1468. [PMID: 37666541 DOI: 10.1136/ijgc-2023-004649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Affiliation(s)
- Parul Barry
- Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Sushil Beriwal
- Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
- Vice President, Varian Systems, Palo Alto, California, USA
| | - Ekta Maheshwari
- Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rohit Bhargava
- Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - William Small
- Radiation Oncology, Cardinal Bernardin Cancer Center, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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Nakamura K, Kitahara Y, Yamashita S, Kigure K, Ito I, Nishimura T, Azuma A, Kanuma T. Reassessment of intensive surveillance practices adopted for endometrial cancer survivors. BMC Womens Health 2022; 22:355. [PMID: 35999573 PMCID: PMC9396785 DOI: 10.1186/s12905-022-01937-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
Background In Japan, 17,000 women are newly diagnosed with endometrial cancer in 2018. The healthcare insurance policy in Japan provides more intensive patient surveillance compared with the United States and European countries. The aim of this study was to retrospectively analyze data, including surveillance methods, recurrence sites, salvage therapy, and survival period after recurrence, to consider the benefits of surveillance for patients with endometrial cancer. Methods Between January 2009 and December 2015, the medical records of patients who were initially diagnosed with the International Federation of Gynecology and Obstetrics stage I–IV endometrial cancer and treated were enrolled in this retrospective study. Only patients with stage IV cancer with peritoneal dissemination were included. Within the first 2 years, the included patients underwent tumor marker tests, Papanicolaou smear test every 1–3-months, and imaging analysis at 6–12- month intervals. Until 4 years, the patients underwent regular surveys every 4 months and imaging analysis annually. Subsequently, the patients received regular surveys every 6 -to 12-months. Results. Among 847 patients, 88 experienced recurrence, and their clinicopathological data were statistically analyzed. The recurrence site was not associated with the initial treatment method or histology. Among the patients with recurrence, 75% were asymptomatic. Univariate analysis demonstrated that time to recurrence and local recurrence were significant factors for survival outcomes, whereas multivariate analysis indicated that only local recurrence was a significant factor. In patients with distant metastasis, neither symptomatic nor asymptomatic recurrence showed a significant difference in survival. Conclusions In this retrospective study, an intensive surveillance protocol did not benefit patients with endometrial cancer. Thus, we hypothesize that the characterization of tumors by emerging technologies that can precisely predict the nature of the tumor will help tailor individualized and efficient surveillance programs. In addition, the ideal salvage therapy needs to be developed to benefit patients after recurrence.
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Sarwar A, Van Griethuysen J, Waterhouse J, Dehbi HM, Eminowicz G, McCormack M. Stratified follow-up for endometrial cancer: a move to more personalized cancer care. Int J Gynecol Cancer 2021; 31:1564-1571. [PMID: 34795021 DOI: 10.1136/ijgc-2021-002903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Hospital based follow-up has been the standard of care for endometrial cancer. Patient initiated follow-up is a useful adjunct for lower risk cancers. The purpose of this study was to evaluate outcomes of endometrial cancer patients after stratification into risk groupings, with particular attention to salvageable relapses. METHODS All patients treated surgically for International Federation of Gynecology and Obstetrics (FIGO) stage I-IVA endometrial cancer of all histological subtypes, from January 2009 until March 2019, were analyzed. Patient and tumor characteristics, treatment details, relapse, death, and last follow-up dates were collected. Site of relapse, presence of symptoms, and whether relapses were salvageable were also identified. The European Society of Medical Oncology-European Society of Gynecological Oncology 2020 risk stratification was assigned, and relapse free and overall survival were estimated. RESULTS 900 patients met the eligibility criteria. Median age was 66 years (range 28-96) and follow-up duration was 35 months (interquartile range 19-57). In total, 16% (n=144) of patients relapsed, 1.3% (n=12) from the low risk group, 3.9% (n=35) from the intermediate risk group, 2.2% (n=20) from the high-intermediate risk group, and 8.7% (n=77) from the high risk group. Salvageable relapses were less frequent at 2% (n=18), of which 33% (n=6) were from the low risk group, 22% (n=4) from the intermediate risk group, 11% (n=2) from the high-intermediate risk group, and 33% (n=6) from the high risk group. There were only three asymptomatic relapses in the low risk patients, accounting for 0.33% of the entire cohort. CONCLUSIONS Relapses were infrequent and most presented with symptoms; prognosis after relapse remains favorable. Overall salvageable relapses were infrequent and cannot justify intensive hospital based follow-up. Use of patient initiated follow-up is therefore appropriate, as per the British Gynaecological Cancer Society's guidelines, for all risk groupings.
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Affiliation(s)
- Asma Sarwar
- University College London Hospitals NHS Foundation Trust, London, UK .,University College London, London, UK
| | | | | | | | - Gemma Eminowicz
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Mary McCormack
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
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Nomura H, Aoki D, Susumu N, Mizuno M, Nakai H, Arai M, Nishio S, Tokunaga H, Nakanishi T, Watanabe Y, Yaegashi N, Yokoyama Y, Takehara K. Analysis of the relapse patterns and risk factors of endometrial cancer following postoperative adjuvant chemotherapy in a phase III randomized clinical trial. Gynecol Oncol 2019; 155:413-419. [DOI: 10.1016/j.ygyno.2019.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 11/17/2022]
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Jeppesen MM, Mogensen O, Hansen DG, Bergholdt SH, Jensen PT. How Do We Follow Up Patients With Endometrial Cancer? Curr Oncol Rep 2019; 21:57. [PMID: 31093835 DOI: 10.1007/s11912-019-0805-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW In this review, we present the existing evidence regarding follow-up care after endometrial cancer, including content of follow-up and type of provider. We furthermore discuss the future perspectives for follow-up care and research in the field. RECENT FINDINGS Recently published randomized controlled trials show that nurse-led telephone follow-up and patient-initiated follow-up are feasible alternatives to routine hospital-based follow-up. No randomized or prospective study has evaluated the effect of routine follow-up on survival. Hence, current knowledge is derived from retrospective studies with the inherent risk of bias. The most important method for recurrence detection is a review of symptoms. There is no evidence to support a survival benefit from the use of routine physical examinations, additional tests, or imaging. One in three of the women attending hospital-based follow-up experience unmet needs, and alternative models for follow-up focused on survivorship care and empowerment should be tested.
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Affiliation(s)
- Mette Moustgaard Jeppesen
- Department of Gynecology and Obstetrics, Lillebaelt Hospital, Kolding, Sygehusvej 24, 6000, Kolding, Denmark.
| | - Ole Mogensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dorte G Hansen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J. B. Winsløws vej 9A, 5000, Odense C, Denmark
| | - Stinne H Bergholdt
- Department of Gynecology and Obstetrics, Odense University Hospital, Sdr Boulevard, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Pernille T Jensen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark
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Trial of Optimal Personalised Care After Treatment—Gynaecological Cancer (TOPCAT-G). Int J Gynecol Cancer 2018; 28:401-411. [DOI: 10.1097/igc.0000000000001179] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Investigation of the clinical features of lower uterine segment carcinoma: association with advanced stage disease and indication of poorer prognosis. Arch Gynecol Obstet 2017; 297:193-198. [PMID: 29116461 DOI: 10.1007/s00404-017-4576-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/10/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE We retrospectively analyzed the differential clinical features and prognosis of endometrial carcinomas arising from the lower uterus, which are reported to have a poorer prognosis than those arising from the upper uterus. METHODS 246 patients with endometrial carcinoma who underwent surgery were entered as subjects. RESULTS Twenty-three were classified as having lower uterine segment carcinomas (LUSC); the remaining 223 were upper uterine segment carcinomas (UUSC). LUSC cases were associated with a more advanced FIGO stage than UUSC (p < 0.001). Deep myometrial invasion and lymph node metastasis were more common in LUSC than in UUSC (p = 0.006 and p < 0.001, respectively). LUSC cases demonstrated significantly shorter overall survival (OS) and progression-free survival (PFS) than UUSC (p = 0.02 and p < 0.001, respectively). Multivariate cox proportional hazards analysis demonstrated that the hazard ratio for LUSC was 1.769 for OS and 3.479 for PFS. For endometrial carcinoma survival, FIGO stage and histological type were extracted as independent variables. CONCLUSIONS LUSC is a high-risk indicator for poorer prognosis for endometrial carcinoma because it is associated with more advanced stage disease, deep myometrial invasion and lymph node metastasis, and indicates a significantly worsened PFS probability. Our analysis concludes that LUSC is FIGO stage-dependent and an important factor for OS.
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Leeson S, Beaver K, Ezendam N, Mačuks R, Martin-Hirsch P, Miles T, Jeppesen M, Jensen P, Zola P. The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials. Eur J Obstet Gynecol Reprod Biol 2017; 210:376-380. [DOI: 10.1016/j.ejogrb.2017.01.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/07/2017] [Accepted: 01/16/2017] [Indexed: 11/17/2022]
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Jeppesen MM, Mogensen O, Hansen DG, Iachina M, Korsholm M, Jensen PT. Detection of recurrence in early stage endometrial cancer - the role of symptoms and routine follow-up. Acta Oncol 2017; 56:262-269. [PMID: 28080157 DOI: 10.1080/0284186x.2016.1267396] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Considerable controversy remains as to the optimal organization of endometrial cancer follow-up. AIM To evaluate the relationship between the way recurrence was detected and survival after treatment for endometrial cancer. Further, to identify characteristics associated with a pre-scheduled examination in women with symptomatic recurrence. MATERIAL AND METHODS All women with early stage endometrial cancer during 2005-2009 were included in a population-based historical cohort derived from the Danish Gynecological Cancer Database. Women diagnosed with recurrence within three years after primary surgery and the mode of recurrence detection were identified from hospital charts: asymptomatic recurrence detected at regular follow-up, symptomatic recurrence detected at regular follow-up or symptomatic recurrence detected in between follow-up. Survival of women with symptomatic and asymptomatic disease was compared. Furthermore, characteristics associated with self-referral as compared to presenting symptoms at regular follow-ups were identified using univariate analyses. RESULTS In total, 183 cases of recurrence (7%) were identified in the cohort of 2612 women. Of these, 65.5% were symptomatic with vaginal bleeding as the most prevalent symptom. Asymptomatic women had a significantly better three-year survival rate compared to symptomatic women (80.3% vs. 54.3%, p < 0.01). A total of 2.3% of the entire population had an asymptomatic recurrence. Women diagnosed at a pre-scheduled visit due to symptoms had a higher educational level (p = 0.03) and more often high-risk disease (p = 0.02) than symptomatic women diagnosed at regular follow-up. CONCLUSION Early stage endometrial cancer carries a low risk of recurrence. Survival appears to be superior in asymptomatic patients, but length-time bias, i.e. the effect of aggressive tumor biology in symptomatic recurrences, may bias results in non-randomized controlled trials. Well educated patients with symptoms of recurrence more often sought medical attendance compared to less educated counterparts. This should be considered if patient-initiated follow-up is the standard care.
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Affiliation(s)
- Mette Moustgaard Jeppesen
- Department of Gynaecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Ole Mogensen
- Department of Obstetrics and Gynaecology, Karolinska University Hospital, Sweden and Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Dorte Gilså Hansen
- The National Research Center of Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Maria Iachina
- The Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Malene Korsholm
- Department of Gynaecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Pernille Tine Jensen
- Department of Gynaecology and Obstetrics, Faculty of Health Sciences, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
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12
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Pye K, Totton N, Stuart N, Whitaker R, Morrison V, Edwards RT, Yeo ST, Timmis LJ, Butterworth C, Hall L, Rai T, Hoare Z, Neal RD, Wilkinson C, Leeson S. Trial of Optimal Personalised Care After Treatment for Gynaecological cancer (TOPCAT-G): a study protocol for a randomised feasibility trial. Pilot Feasibility Stud 2016; 2:67. [PMID: 27965882 PMCID: PMC5154014 DOI: 10.1186/s40814-016-0108-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/08/2016] [Indexed: 12/16/2022] Open
Abstract
Background Gynaecological cancers are diagnosed in over 1000 women in Wales every year. We estimate that this is costing the National Health Service (NHS) in excess of £1 million per annum for routine follow-up appointments alone. Follow-up care is not evidence-based, and there are no definitive guidelines from The National Institute for Health and Care Excellence (NICE) for the type of follow-up that should be delivered. Standard care is to provide a regular medical review of the patient in a hospital-based outpatient clinic for a minimum of 5 years. This study is to evaluate the feasibility of a proposed alternative where the patients are delivered a specialist nurse-led telephone intervention known as Optimal Personalised Care After Treatment for Gynaecological cancer (OPCAT-G), which comprised of a protocol-based patient education, patient empowerment and structured needs assessment. Methods The study will recruit female patients who have completed treatment for cervical, endometrial, epithelial ovarian or vulval cancer within the previous 3 months in Betsi Cadwaladr University Health Board (BCUHB) in North Wales. Following recruitment, participants will be randomised to one of two arms in the trial (standard care or OPCAT-G intervention). The primary outcomes for the trial are patient recruitment and attrition rates, and the secondary outcomes are quality of life, health status and capability, using the EORTC QLQ-C30, EQ-5D-3L and ICECAP-A measures. Additionally, a client service receipt inventory (CSRI) will be collected in order to pilot an economic evaluation. Discussion The results from this feasibility study will be used to inform a fully powered randomised controlled trial to evaluate the difference between standard care and the OPCAT-G intervention. Trial registration ISRCTN45565436.
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Affiliation(s)
- Kirstie Pye
- North Wales Organisation for Randomised Trials in Health (NWORTH), IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Nicola Totton
- North Wales Organisation for Randomised Trials in Health (NWORTH), IMSCaR, COHABS, Bangor University, Bangor, UK
| | | | | | - Val Morrison
- School of Psychology, COHABS, Bangor University, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Laura J Timmis
- Centre for Health Economics and Medicines Evaluation, IMSCaR, COHABS, Bangor University, Bangor, UK
| | | | - Liz Hall
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Tekendra Rai
- North Wales Organisation for Randomised Trials in Health (NWORTH), IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH), IMSCaR, COHABS, Bangor University, Bangor, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, COHABS, Bangor University, Bangor, UK
| | - Simon Leeson
- Betsi Cadwaladr University Health Board, Bangor, UK
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13
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Aslam RW, Spencer LH, Pye KL, Leeson S. Follow-up strategies for women with endometrial cancer after primary treatment. Hippokratia 2016. [DOI: 10.1002/14651858.cd012386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rabeea'h W Aslam
- Department of Population Health; London School of Hygiene & Tropical Medicine; London UK
| | - Llinos H Spencer
- NWORTH (LLAIS) and CHEME (Health and Care Economics Cymru); Bangor University; Bangor, Gwynedd UK
| | - Kirstie L Pye
- North Wales Organisation for Randomised Trials in Health (NWORTH); Bangor University; Bangor UK
| | - Simon Leeson
- Department of Obstetrics and Gynaecology; Betsi Cadwaladr University Health Board; Bangor UK
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14
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Yoshiba T, Takei Y, Machida S, Taneichi A, Sato N, Takahashi S, Takahashi Y, Saga Y, Matsubara S, Fujiwara H. Prognosis of endometrial cancer patients with and without symptoms at recurrence. J Obstet Gynaecol Res 2016; 42:1814-1821. [PMID: 27526662 DOI: 10.1111/jog.13112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
Abstract
AIM During routine follow-up for postoperative endometrial cancer, we have encountered patients with and without symptoms at recurrence. In this study, we investigated whether or not there is a difference in the prognosis between patients with and without symptoms at recurrence. METHODS We reviewed endometrial cancer patients who had been treated in our hospital between 1998 and 2007. Routine follow-up was conducted by our facility criteria. We investigated recurrence-free survival (RFS), presence or absence of symptoms at recurrence, overall survival from recurrence (OSFR), and overall survival (OS). RESULTS The subjects were 293 patients. Recurrence was detected in 46 patients. The median RFS was 15 (1-103) months. At the time of recurrence, symptoms were present in 14 patients and absent in 32 patients. In groups with and without symptoms at recurrence, the median OSFR were 36 (2-100) and 45 (2-139) months, respectively. The median OS were 55 (6-163) and 100 (11-178) months, respectively. There were no significant differences in either parameter. Independent prognostic factors for OSFR and OS were histopathologic types other than endometrioid carcinoma (vs endometrioid carcinoma, hazard ratio = 3.102 and 3.008, respectively) and RFS of 14 months or shorter (vs 15 months or longer, hazard ratio = 2.378 and 3.739, respectively). CONCLUSION There was no difference in the prognosis between the groups with and without symptoms at recurrence. Independent prognostic factors of recurrent patients were histopathologic types and RFS. A large-scale study should be conducted to examine the necessity of routine follow-up for detecting recurrence in the absence of symptoms.
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Affiliation(s)
- Takahiro Yoshiba
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Yuji Takei
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Shizuo Machida
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Akiyo Taneichi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Naoto Sato
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Suzuyo Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Yoshifumi Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Yasushi Saga
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
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15
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Shimamoto K, Saito T, Okadome M, Shimokawa M. Prognostic significance of the treatment-free interval in patients with recurrent endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2014; 175:92-6. [PMID: 24472691 DOI: 10.1016/j.ejogrb.2014.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 12/16/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify prognostic factors of recurrent endometrial cancer, and clarify whether the treatment-free interval (TFI) predicts outcome in a wide spectrum of patients. STUDY DESIGN The clinical data of 60 patients treated for recurrent stage I-IV endometrial cancer between 1997 and 2012 were reviewed retrospectively. The Kaplan-Meier method and Cox regression analysis were used to estimate overall survival (OS) following recurrence and determine the factors influencing outcomes. RESULTS The median age at initial treatment was 59 (range 38-80) years and the median post-recurrence overall survival time was 40.0 (range 1.8-156.7) months. Multivariate analysis showed lymph node metastasis (hazard ratio (HR) 2.80; 95% confidence interval (95%CI) 1.29-6.09; p=0.009), TFI (HR 0.33; 95% CI 0.15-0.76; p=0.008), and symptomatic recurrence (HR 2.31, 95% CI 1.11-4.83, p=0.0025) were independent prognostic factors. Patients whose tumors recurred after a TFI≥12 months had better response rates than did those with a TFI<12 months (p<0.001). CONCLUSION TFI is a significant prognostic factor in recurrent endometrial cancer. Furthermore, the effect of chemotherapy on recurrent endometrial cancer is probably influenced by the duration of TFI.
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Affiliation(s)
- Kumi Shimamoto
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan
| | - Toshiaki Saito
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan.
| | - Masao Okadome
- Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan
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Omitting Adjuvant Radiotherapy in Endometrial Cancer Increases the Rate of Locoregional Recurrences but Has no Effect on Long-Term Survival. Int J Gynecol Cancer 2013; 23:1429-37. [DOI: 10.1097/igc.0b013e3182a5e77d] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mokhtar NM, Ramzi NH, Yin-Ling W, Rose IM, Hatta Mohd Dali AZ, Jamal R. Laser capture microdissection with genome-wide expression profiling displayed gene expression signatures in endometrioid endometrial cancer. Cancer Invest 2011; 30:156-64. [PMID: 22122087 DOI: 10.3109/07357907.2011.633290] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This research determined genes contributing to the pathogenesis of endometrioid endometrial cancer (EEC). Eight pairs of microdissected EEC samples matched with normal glandular epithelium were analyzed using microarray. Unsupervised analysis identified 162 transcripts (58 up- and 104 down-regulated) that were differentially expressed (p < .01, fold change ≥ 1.5) between both groups. Quantitative real-time polymerase chain reaction (qPCR) validated the genes of interest: SLC7A5, SATB1, H19, and ZAK (p < .05). Pathway analysis revealed genes involved in acid amino transport, translation, and chromatin remodeling (p < .05). Laser capture microdissection (LCM) followed by microarray enabled precise assessment of homogeneous cell population and identified putative genes for endometrial carcinogenesis.
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Affiliation(s)
- Norfilza Mohd Mokhtar
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras 56000, Kuala Lumpur, Malaysia.
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