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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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Sandell T, Schütze H, Miller A. Acceptability of a shared cancer follow-up model of care between general practitioners and radiation oncologists: A qualitative evaluation. Health Expect 2023; 26:2441-2452. [PMID: 37583292 PMCID: PMC10632636 DOI: 10.1111/hex.13846] [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: 03/21/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Facilitators to implement shared cancer follow-up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two-way information sharing and clear follow-up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. METHODS Semi-structured interviews were conducted pre- and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. RESULTS Thirty-two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow-up care, however, patients were concerned about the GPs cancer-specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low-risk, stable patients around 2-3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow-up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. CONCLUSION Patients, GPs and ROs felt this shared cancer follow-up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. PATIENT OR PUBLIC CONTRIBUTION Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed.
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Affiliation(s)
- Tiffany Sandell
- School of Graduate MedicineFaculty of Science, Medicine and Health, University of WollongongWollongongNew South WalesAustralia
- Illawarra Shoalhaven Local Health District, Cancer ServicesNowraNew South WalesAustralia
| | - Heike Schütze
- School of Graduate MedicineFaculty of Science, Medicine and Health, University of WollongongWollongongNew South WalesAustralia
- Office of Medical EducationFaculty of Medicine and Health, University of New South WalesSydneyNew South WalesAustralia
| | - Andrew Miller
- Illawarra Shoalhaven Local Health District, Cancer ServicesNowraNew South WalesAustralia
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Zachou G, El-Khouly F, Dilley J. Evaluation of follow-up strategies for women with epithelial ovarian cancer following completion of primary treatment. Cochrane Database Syst Rev 2023; 8:CD006119. [PMID: 37650760 PMCID: PMC10471005 DOI: 10.1002/14651858.cd006119.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND This is an update of a previous Cochrane Review, last updated in 2014. Ovarian cancer is the eighth most common cancer and seventh most common cause of death due to cancer in women worldwide. Traditionally, most women who have been treated for cancer undergo long-term follow-up in secondary care. However, it has been suggested that the use of routine review may not be effective in improving survival, or health-related quality of life (HRQOL), or relieving anxiety. In addition, traditional follow-up may not be cost-effective. OBJECTIVES To compare the potential effects of different strategies of follow-up in women with epithelial ovarian cancer, following completion of primary treatment. SEARCH METHODS For this update, we searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL 2022, Issue 11, MEDLINE, and Embase from August 2013 to November 2022. We also searched review articles and contacted experts in the field. SELECTION CRITERIA All randomised controlled trials (RCTs) that evaluated follow-up strategies for women with epithelial ovarian cancer following completion of primary treatment. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. Two review authors independently selected potentially relevant trials, extracted data, and assessed risk of bias. They compared results, and resolved disagreements by discussion. We assessed the certainty of evidence, using the GRADE approach, for the outcomes of interest: overall survival (OS), health-related quality of life (HRQOL), psychological effects, and cost analysis. MAIN RESULTS For this update, we included one new RCT, including 112 women with ovarian, fallopian tube, or peritoneal cancer, who had completed primary treatment by surgery, with or without chemotherapy. This study reported the effect of individualised, i.e. individually tailored, nurse-led follow-up versus conventional medical follow-up on HRQOL, psychological outcomes, and cost-analysis. Individualised follow-up improved HRQOL in one of the two scales, with a decrease in mean difference (MD) in the QLQ-C30 discomfort scale following 12 months of individualised treatment compared to 12 months of conventional treatment (MD -5.76 points, 95% confidence interval (CI) -10.92 to -0.60; 1 study, 112 participants; low-certainty evidence; minimal important difference 4 to 10 points). There may be little or no difference in the other HRQOL scale (QLQ-Ov28, MD -0.97 points, 95% CI -2.57 to 0.63; 1 study, 112 participants: low-certainty evidence); psychological outcome, measured with the hospital anxiety and depression scale (HADS; MD 0.10 point, 95% CI -0.81 to 1.02; 1 study, 112 participants: low-certainty evidence), or cost analysis (MD -GBP 695.00, 95% CI -1467.23 to 77.23; 1 study, 112 participants: moderate-certainty evidence). Our previous review included one RCT, with 529 women in a confirmed remission, with normal CA125 concentration and no radiological evidence of disease, after surgery and first-line chemotherapy for ovarian cancer. This study evaluated immediate treatment of ovarian cancer relapse following a rise of serum CA125 levels versus delaying treatment until symptoms developed for OS, and HRQOL. There was little or no difference in OS between the immediate and delayed arms after a median follow-up of 56.9 months (unadjusted hazard ratio (HR) 0.98, 95% CI 0.80 to 1.20; 1 study, 529 participants; moderate-certainty evidence). Time from randomisation to first deterioration in global health score or death was shorter in the immediate treatment group than in the delayed treatment group (HR 0.71, 95% CI 0.58 to 0.88). AUTHORS' CONCLUSIONS Limited evidence from one trial suggests that routine surveillance with CA125 in asymptomatic women and treatment at CA125-defined relapse does not seem to offer survival advantage when compared to treatment at symptomatic relapse. However, this study pre-dates the use of PARPi maintenance treatment and the increased use of secondary cytoreductive surgery, so the results may be limited in their applicability to current practice. Limited evidence from one trial suggests that individualised nurse-led follow-up may improve HRQOL in women with ovarian cancer following completion of primary treatment. Large RCTs are needed to compare different types of follow-up, looking at survival, HRQOL, psychological effects, and cost as outcomes.
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Affiliation(s)
- Georgia Zachou
- Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Fatima El-Khouly
- Medical Oncology, Barking, Havering and Redbridge University Hospital NHS Trust, London, UK
| | - James Dilley
- Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London, UK
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Amirthanayagam A, Boulter L, Millet N, McDermott HJ, Morrison J, Taylor A, Miles T, Coton L, Moss EL. Risk Stratified Follow-Up for Endometrial Cancer: The Clinicians' Perspective. Curr Oncol 2023; 30:2237-2248. [PMID: 36826134 PMCID: PMC9955652 DOI: 10.3390/curroncol30020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
Risk-stratified follow-up for endometrial cancer (EC) is being introduced in many cancer centres; however, there appears to be diversity in the structure and availability of schemes across the UK. This study aimed to investigate clinicians' and clinical specialist nurses' (CNS) experiences of follow-up schemes for EC, including patient-initiated follow-up (PIFU), telephone follow-up (TFU) and clinician-led hospital follow-up (HFU). A mixed-methods study was conducted, consisting of an online questionnaire to CNSs, an audience survey of participants attending a national "Personalising Endometrial Cancer Follow-up" educational meeting, and qualitative semi-structured telephone interviews with clinicians involved in the follow-up of EC. Thematic analysis identified three main themes to describe clinicians' views: appropriate patient selection; changing from HFU to PIFU schemes; and the future of EC follow-up schemes. Many participants reported that the COVID-19 pandemic impacted EC follow-up by accelerating the transition to PIFU/TFU. Overall, there was increasing support for non-HFU schemes for patients who have completed primary treatment of EC; however, barriers were identified for non-English-speaking patients and those who had communication challenges. Given the good long-term outcome associated with EC, greater focus is needed to develop resources to support patients post-treatment and individualise follow-up according to patients' personal needs and preferences.
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Affiliation(s)
| | - Louise Boulter
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Nessa Millet
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Hilary J. McDermott
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Jo Morrison
- Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | | | - Tracie Miles
- Royal United Hospital Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Lorna Coton
- Royal United Hospital Bath NHS Foundation Trust, Bath BA1 3NG, UK
| | - Esther L. Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Department of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
- Correspondence:
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Newton C, Beaver K, Clegg A. Patient initiated follow-up in cancer patients: A systematic review. Front Oncol 2022; 12:954854. [PMID: 36313728 PMCID: PMC9606321 DOI: 10.3389/fonc.2022.954854] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patient-initiated follow-up (PIFU) is increasingly being implemented for oncology patients, particularly during the COVID-19 pandemic, given the necessary reduction in face-to-face hospital outpatient appointments. We do not know if PIFU has a positive (or negative) impact on overall, or progression free, survival. Objectives To investigate the impact of PIFU on overall survival, progression free survival, patient satisfaction, psychological morbidity, specifically quality of life (QoL) and economic costs compared to hospital follow up (HFU), for any type of cancer. Methods We carried out a systematic review using five electronic databases: MEDLINE, CINAHL, EMBASE, PsycInfo and Cochrane Central Register of Controlled Trials. Studies were eligible if they were controlled clinical trials comparing PIFU with another form of active follow-up. Effectiveness was assessed using the primary outcome of overall survival and secondary outcomes of progression free survival, patient satisfaction, psychological morbidity, QoL and cost effectiveness. Results Eight studies met the inclusion criteria and were included. Only one study included survival as a primary outcome and indicated no significant differences between hospital-based follow-up and PIFU, although not adequately powered to detect a difference in survival. For secondary outcomes, few differences were found between PIFU and other forms of active follow-up. One study reported significant differences in fear of cancer recurrence between PIFU and HFU although did not reach the limit of clinical significance; in the short term, fear decreased significantly more in hospital based follow-up. Conclusion We do not have evidence to support the impact of PIFU on survival or progression free survival. Fully powered randomized controlled trials are required to determine the full impact of PIFU in the longer term.
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Kennedy F, Shearsmith L, Holmes M, Rogers Z, Carter R, Hofmann U, Velikova G. Electronic patient-reported monitoring of symptoms during follow-up of ovarian cancer patients: a feasibility study. BMC Cancer 2022; 22:726. [PMID: 35780095 PMCID: PMC9250717 DOI: 10.1186/s12885-022-09817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ovarian cancer patients require monitoring for relapse. Innovative follow-up methods are increasingly being explored. An electronic patient-reported outcome (ePRO) follow-up pathway was developed for women treated for ovarian cancer. This feasibility study explored patient acceptability and compliance. Methods A single-arm non-blinded prospective feasibility study was undertaken at two hospitals. Participants were women who had completed treatment for ovarian cancer whose clinician was happy for them to be monitored remotely. Automated 3-monthly reminders were sent to participants to complete an ePRO questionnaire and obtain blood tests. Participants were reviewed over the phone by their clinical nurse specialist instead of attending clinic-based follow-up. The primary outcome was compliance (expected ePRO completions/blood tests) across the 12-month study period. Secondary outcomes were recruitment, attrition, resource use, symptom severity/alerts and patient acceptability. Results Twenty-four women consented (50% consent rate), and 13 remained on study at 12 months. Seven women relapsed, 3 chose to withdraw, and 1 withdrew for other clinical reasons. ePRO compliance was high and consistent at 75-82%, although the two hospitals differed. Adherence to the clinical protocol was evident for blood tests and contacts with staff (fewer visits, more phonecalls compared to an earlier audit). End-of-study feedback indicated high patient satisfaction. Conclusions Remote ePRO follow-up for ovarian cancer is feasible and acceptable to patients who are able and willing to participate. However, the low recruitment rate (ineligible + declined) indicate it is not suitable/acceptable to all patients immediately post-treatment. Further large-scale research and implementation work is required, especially in a post-COVID era. Trial registration ClinicalTrials.gov ID: NCT02847715 (first registered 19/05/2016). Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09817-5.
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Affiliation(s)
- Fiona Kennedy
- Section of Patient Centred Outcomes Research, Patient Reported Outcomes Group, Leeds Institute of Medical Research at St James's, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK.
| | - Leanne Shearsmith
- Section of Patient Centred Outcomes Research, Patient Reported Outcomes Group, Leeds Institute of Medical Research at St James's, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
| | - Marie Holmes
- Section of Patient Centred Outcomes Research, Patient Reported Outcomes Group, Leeds Institute of Medical Research at St James's, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
| | - Zoe Rogers
- Section of Patient Centred Outcomes Research, Patient Reported Outcomes Group, Leeds Institute of Medical Research at St James's, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
| | - Rob Carter
- Section of Patient Centred Outcomes Research, Patient Reported Outcomes Group, Leeds Institute of Medical Research at St James's, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
| | - Uschi Hofmann
- Calderdale & Huddersfield NHS Foundation Trust, Huddersfield Royal Infirmary, Acre St, Lindley, Huddersfield, HD3 3EA, UK
| | - Galina Velikova
- Section of Patient Centred Outcomes Research, Patient Reported Outcomes Group, Leeds Institute of Medical Research at St James's, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
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Morrison J, Balega J, Buckley L, Clamp A, Crosbie E, Drew Y, Durrant L, Forrest J, Fotopoulou C, Gajjar K, Ganesan R, Gupta J, Hughes J, Miles T, Moss E, Nanthakumar M, Newton C, Ryan N, Walther A, Taylor A. British Gynaecological Cancer Society (BGCS) uterine cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2022; 270:50-89. [DOI: 10.1016/j.ejogrb.2021.11.423] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022]
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Kennedy F, Shearsmith L, Holmes M, Peacock R, Lindner OC, Megson M, Velikova G. 'We do need to keep some human touch'-Patient and clinician experiences of ovarian cancer follow-up and the potential for an electronic patient-reported outcome pathway: A qualitative interview study. Eur J Cancer Care (Engl) 2022; 31:e13557. [PMID: 35146821 PMCID: PMC9287040 DOI: 10.1111/ecc.13557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/30/2021] [Accepted: 01/26/2022] [Indexed: 12/29/2022]
Abstract
Objective This study aimed to explore experiences of follow‐up after treatment and views on an electronic patient‐reported outcome (ePRO) pathway among ovarian cancer patients and clinicians. Methods Semi‐structured qualitative interviews were conducted with clinicians and patients previously treated for ovarian cancer. Interviews explored experiences of the current follow‐up pathway, patients' needs and views on an ePRO pathway enabling patients to report symptoms online rather than attend clinic‐based appointments. Transcripts were analysed using framework analysis. Results Sixteen patients and 10 clinicians participated from four hospitals in England. Four key themes were identified: transition into follow‐up, key features of effective follow‐up, issues in follow‐up and views of ePRO. Both patients and clinicians saw benefits of an ePRO pathway alongside continued access to specialist support and discussed various practicalities (e.g., frequency, introduction and communication). Technology concerns and feelings of abandonment were highlighted as barriers. The proposed impact on clinical and individual patient outcomes was discussed. Conclusion Patient and clinician views on follow‐up and an ePRO pathway informed key recommendations on the development/introduction of ePRO follow‐up. Technology use in healthcare will continue to grow and may offer solutions to facilitate responsive and tailored care. Further research should explore the safety, experiences and acceptability of ePRO follow‐up.
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Affiliation(s)
- Fiona Kennedy
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research (LIMR) at St James's, University of Leeds, Leeds, UK
| | - Leanne Shearsmith
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research (LIMR) at St James's, University of Leeds, Leeds, UK.,Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Marie Holmes
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research (LIMR) at St James's, University of Leeds, Leeds, UK
| | - Rosemary Peacock
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research (LIMR) at St James's, University of Leeds, Leeds, UK
| | - Oana C Lindner
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research (LIMR) at St James's, University of Leeds, Leeds, UK
| | - Molly Megson
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research (LIMR) at St James's, University of Leeds, Leeds, UK.,Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Galina Velikova
- Section of Patient-Centred Outcomes Research, Leeds Institute of Medical Research (LIMR) at St James's, University of Leeds, Leeds, UK
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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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Stage one endometrioid endometrial adenocarcinoma: is there a role of traditional hospital follow-up in the detection of cancer recurrence in women after treatment? Obstet Gynecol Sci 2021; 64:506-516. [PMID: 34517692 PMCID: PMC8595042 DOI: 10.5468/ogs.21137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/17/2021] [Indexed: 11/12/2022] Open
Abstract
Objective To investigate the rate of asymptomatic recurrence of stage 1 endometrioid endometrial cancer and assess the role of routine hospital follow-up after treatment. Methods We performed a retrospective case-note review study of women who were diagnosed with stage 1 endometrioid endometrial adenocarcinoma at Queen’s Hospital, Romford, between January 2008 and December 2016. Results We included 299 patients with a median follow-up period of 44.4 months. All the patients underwent total hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy was offered to the patients subsequent to discussions in the multidisciplinary team meeting in accordance with the risk stratification criteria. There was no significant correlation between the risk factors and disease recurrence. In total, 11 patients presented with recurrent disease with original staging: 1a, n=6/199; and 1b, n=5/100. Four patients presented with vaginal bleeding due to vault recurrence and one patient with abdominal pain due to pelvic mass. Locoregional recurrence was an incidental finding in two other patients. Four patients presented with symptomatic distant metastases to the lung (n=2), liver (n=1), and bone (n=1). No asymptomatic recurrences were identified on routine follow-ups, despite several hospital appointments and clinical examinations. The recurrence rate for patients with stage 1a and 1b, grade 1, and grade 2 disease was 3.53%, and that for patients with stage 1a, grade 1, and grade 2 disease was 2.7%. Conclusion Routine clinical examinations have a low yield in finding recurrence in asymptomatic women and should be questioned for their value, considering the limited resources of the National Health Service (NHS). Larger studies are required to support a stratified follow-up, which will include telephone and patient-initiated follow-up.
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Luqman I, Wickham-Joseph R, Cooper N, Boulter L, Patel N, Kumarakulasingam P, Moss EL. Patient-initiated follow-up for low-risk endometrial cancer: a cost-analysis evaluation. Int J Gynecol Cancer 2020; 30:1000-1004. [DOI: 10.1136/ijgc-2019-001074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/10/2023] Open
Abstract
ObjectiveRisk stratification has resulted in patient-initiated follow-up being introduced for low-risk endometrial cancer in place of routine hospital follow-up. The financial benefit to the patient and the healthcare economy of patient-initiated follow-up, as compared with hospital follow-up, has yet to be explored. In this study, we explored the potential impact for both the healthcare economy and patients of patient-initiated follow-up.MethodsWomen diagnosed with low-risk endometrial cancer enrolled on a patient-initiated follow-up scheme between November 2014 and September 2018 were included. Data on the number of telephone calls to the nurse specialists and clinic appointments attended were collected prospectively. The number of clinic appointments that would have taken place if the patient had continued on hospital follow-up, rather than starting on patient-initiated follow-up, was calculated and costs determined using standard National Health Service (NHS) reference costs. The time/distance traveled by patients from their home address to the hospital clinic was calculated and used to determine patient-related costs.ResultsA total of 187 patients with a median of 37 (range 2–62) months follow-up after primary surgery were enrolled on the scheme. In total, the cohort were scheduled to attend 1673 appointments with hospital follow-up, whereas they only attended 69 clinic appointments and made 107 telephone contacts with patient-initiated follow-up. There was a 93.5% reduction in costs from a projected £194 068.00 for hospital follow-up to £12 676.33 for patient-initiated follow-up. The mean patient-related costs were reduced by 95.6% with patient-initiated follow-up. The total mileage traveled by patients for hospital follow-up was 30 891.4 miles, which was associated with a mean traveling time per patient of 7.41 hours and clinic/waiting time of 7.5 hours compared with 1165.8 miles and 0.46 hours and 0.5 hours, respectively, for patient-initiated follow-up.ConclusionThe introduction of a patient self-management follow-up scheme for low-risk endometrial cancer was associated with financial/time saving to both the patient and the healthcare economy as compared with hospital follow-up.
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12
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Coleman L, Newton C. Patient initiated follow up after gynaecological malignancy: National survey of current UK practice. Eur J Obstet Gynecol Reprod Biol 2020; 248:193-197. [DOI: 10.1016/j.ejogrb.2020.03.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/16/2020] [Indexed: 11/27/2022]
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Newton C, Nordin A, Rolland P, Ind T, Larsen-Disney P, Martin-Hirsch P, Beaver K, Bolton H, Peevor R, Fernandes A, Kew F, Sengupta P, Miles T, Buckley L, Manderville H, Gajjar K, Morrison J, Ledermann J, Frost J, Lawrence A, Sundar S, Fotopoulou C. British Gynaecological Cancer Society recommendations and guidance on patient-initiated follow-up (PIFU). Int J Gynecol Cancer 2020; 30:695-700. [DOI: 10.1136/ijgc-2019-001176] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/06/2020] [Accepted: 02/11/2020] [Indexed: 01/01/2023] Open
Abstract
The National Cancer Survivorship Initiative through the National Health Service (NHS) improvement in the UK started the implementation of stratified pathways of patient-initiated follow-up (PIFU) across various tumor types. Now the initiative is continued through the Living With and Beyond Cancer program by NHS England. Evidence from non-randomized studies and systematic reviews does not demonstrate a survival advantage to the long-established practice of hospital-based follow-up regimens, traditionally over 5 years. Evidence shows that patient needs are inadequately met under the traditional follow-up programs and there is therefore an urgent need to adapt pathways to the needs of patients. The assumption that hospital-based follow-up is able to detect cancer recurrences early and hence improve patient prognosis has not been validated. A recent survey demonstrates that follow-up practice across the UK varies widely, with telephone follow-up clinics, nurse-led clinics and PIFU becoming increasingly common. There are currently no completed randomized controlled trials in PIFU in gynecological malignancies, although there is a drive towards implementing PIFU. PIFU aims to individualize patient care, based on risk of recurrence and holistic needs, and optimizing resources. The British Gynaecological Cancer Society wishes to provide the gynecological oncology community with guidance and a recommendations statement regarding the value, indications, and limitations of PIFU in endometrial, cervical, ovarian, and vulvar cancers in an effort to standardize practice and improve patient care.
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Beaver K, Williamson S, Sutton CJ, Gardner A, Martin-Hirsch P. Endometrial cancer patients' preferences for follow-up after treatment: A cross-sectional survey. Eur J Oncol Nurs 2020; 45:101722. [PMID: 32014709 DOI: 10.1016/j.ejon.2020.101722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Alternatives to hospital follow-up (HFU) following treatment for cancer have been advocated. Telephone follow-up (TFU) and patient-initiated follow-up are being implemented but it is unclear if these approaches will meet the preferences and needs of patients. This study aimed to explore the preferences of endometrial cancer patients and their levels of satisfaction with HFU and nurse-led TFU. METHODS A cross-sectional survey design was utilised and a questionnaire was administered to 236 patients who had participated in a randomised controlled trial comparing HFU with TFU for women diagnosed with Stage I endometrial cancer (ENDCAT trial). RESULTS 211 (89.4%) patients returned the questionnaire; 105 in the TFU group and 106 in the HFU group. The TFU group were more likely to indicate that appointments were on time (p < 0.001) and were more likely to report that their appointments were thorough (p = 0.011). Participants tended to prefer what was familiar to them. Those in the HFU group tended to prefer hospital-based appointments while the TFU group tended to prefer appointments with a clinical nurse specialist, regardless of locality. CONCLUSIONS To provide patient centred follow-up services we need to ensure that patient preferences are taken into account and understand that patients may come to prefer what they have experienced. Patient initiated approaches may become standard and preferred practice but TFU remains a high-quality alternative to HFU and may provide an effective transition between HFU and patient-initiated approaches.
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Affiliation(s)
- Kinta Beaver
- School of Sport & Health Sciences, Faculty of Health & Wellbeing, Brook Building, University of Central Lancashire, Preston, Lancashire, PR1 2HE, United Kingdom.
| | - Susan Williamson
- School of Sport & Health Sciences, Faculty of Health & Wellbeing, Brook Building, University of Central Lancashire, Preston, Lancashire, PR1 2HE, United Kingdom.
| | - Chris J Sutton
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, Jean McFarlane Building, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom.
| | - Anne Gardner
- Women's Health Research Department, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, Lancashire, PR2 9HT, United Kingdom.
| | - Pierre Martin-Hirsch
- Department of Obstetrics & Gynaecology, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, Lancashire, PR2 9HT, United Kingdom.
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Simsek SY, Serbetcioglu G, Alemdaroglu S, Yetkinel S, Durdag GD, Celik H. Clinicopathologic characteristics of recurrent endometrioid endometrial cancer patients and analysis of methods used durıing surveillance. J Gynecol Obstet Hum Reprod 2019; 48:473-477. [PMID: 31212025 DOI: 10.1016/j.jogoh.2019.06.004] [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: 03/26/2019] [Revised: 05/07/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine cilinicopathologic characteristics of recurrent endometrioid type endometrial cancer patients and analyze the methods applied in detection of recurrent disease during follow-up period. METHODS We have retrospectively reviewed the file records of the 226 patients who had endometrioid type carcinoma. Bimanual pelvic examination, speculum examination, carcinogenic antigen-125 (CA125) testing, vaginal cuff cytologic screening, transabdominal ultrasound (TAUS) and transvaginal ultrasound(TVUS) imagings were performed within the context of routine follow-up control examinations in the post-treatment period in every 3 months within the first 2 years and in every 6 months in the following 2 years and with annual control in the consecutive years. RESULTS Mean follow-up durations was 25.7±18.9 months while recurrence rate was 3.1%. The study patient group underwent totally 1116 times TVUS and 1084 times whole TA-US evaluations, 973 times vaginal cuff cytological screening, 1125 times pelvic and general physical examinations beside 1060 times CA-125 testings were performed in accordance with our routinely performed follow-up protocol. The asymptomatic recurrent cases ; one of those was dignosed with pelvic examination while diagnosis was established using TA-USG evaluation in the other asymptomatic patient. The other 5 cases were symptomatic. Pelvic examination, Computed Tomograhy and Magnetic Resonance Imaging were utilized in diagnosing 1, 3 and 1 of those patients, respectively. CONCLUSION The presence of symptoms and pelvic examination seem to be the most effective modalities in detecting recurrence in follow-up of endometrial cancer. It would be reasonable to optimize intervals between follow-up visits and to determine the appropriate evaluations by considering risk levels of the patients.
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Affiliation(s)
- S Y Simsek
- Baskent University Adana Dr. Turgut Noyan Teaching Hospital, Turkey.
| | - G Serbetcioglu
- Baskent University Izmir Zubeyde Hanım Research Hospital, Turkey
| | - S Alemdaroglu
- Baskent University Adana Dr. Turgut Noyan Teaching Hospital, Turkey
| | - S Yetkinel
- Baskent University Adana Dr. Turgut Noyan Teaching Hospital, Turkey
| | - G D Durdag
- Baskent University Adana Dr. Turgut Noyan Teaching Hospital, Turkey
| | - H Celik
- Baskent University Adana Dr. Turgut Noyan Teaching Hospital, Turkey; Baskent University Izmir Zubeyde Hanım Research Hospital, Turkey
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16
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17
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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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18
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Taarnhøj GA, Christensen IJ, Lajer H, Fuglsang K, Jeppesen MM, Kahr HS, Høgdall C. Risk of recurrence, prognosis, and follow-up for Danish women with cervical cancer in 2005-2013: A national cohort study. Cancer 2017; 124:943-951. [DOI: 10.1002/cncr.31165] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Henrik Lajer
- Department of Gynecology; Rigshospitalet; Copenhagen Denmark
| | - Katrine Fuglsang
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
| | | | - Henriette Strøm Kahr
- Department of Gynecology and Obstetrics; Aalborg University Hospital; Aalborg Denmark
| | - Claus Høgdall
- Department of Gynecology; Rigshospitalet; Copenhagen Denmark
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19
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Boaventura CS, Rodrigues DP, Silva OAC, Beltrani FH, de Melo RAB, Bitencourt AGV, Mendes GG, Chojniak R. Evaluation of the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer, according to the American College of Radiology criteria. Radiol Bras 2017; 50:1-6. [PMID: 28298725 PMCID: PMC5347495 DOI: 10.1590/0100-3984.2015.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the indications for performing magnetic resonance imaging of the
female pelvis at a referral center for cancer. Materials and Methods This was a retrospective, single-center study, conducted by reviewing medical
records and imaging reports. We included 1060 female patients who underwent
magnetic resonance imaging of the pelvis at a cancer center between January
2013 and June 2014. The indications for performing the examination were
classified according to the American College of Radiology (ACR)
criteria. Results The mean age of the patients was 52.6 ± 14.8 years, and 49.8% were
perimenopausal or postmenopausal. The majority (63.9%) had a history of
cancer, which was gynecologic in 29.5% and nongynecologic in 34.4%. Of the
patients evaluated, 44.0% had clinical complaints, the most common being
pelvic pain (in 11.5%) and bleeding (in 9.8%), and 34.7% of patients had
previously had abnormal findings on ultrasound. Most (76.7%) of the patients
met the criteria for undergoing magnetic resonance imaging, according to the
ACR guidelines. The main indications were evaluation of tumor recurrence
after surgical resection (in 25.9%); detection and staging of gynecologic
neoplasms (in 23.3%); and evaluation of pelvic pain or of a mass (in
17.1%). Conclusion In the majority of the cases evaluated, magnetic resonance imaging was
clearly indicated according to the ACR criteria. The main indication was
local recurrence after surgical treatment of pelvic malignancies, which is
consistent with the routine protocols at cancer centers.
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Affiliation(s)
| | | | | | | | | | | | | | - Rubens Chojniak
- PhD, MD, Head of the Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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20
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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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Lanceley A, Berzuini C, Burnell M, Gessler S, Morris S, Ryan A, Ledermann JA, Jacobs I. Ovarian Cancer Follow-up: A Preliminary Comparison of 2 Approaches. Int J Gynecol Cancer 2017; 27:59-68. [PMID: 28002208 DOI: 10.1097/igc.0000000000000877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of the study was to perform a preliminary comparison of quality of life (QoL) and patient satisfaction in individualized nurse-led follow-up versus conventional medical follow-up in ovarian cancer. METHODS One hundred twelve women who received a diagnosis of ovarian, fallopian tube, or peritoneal cancer, completed primary treatment by surgery alone or with chemotherapy, irrespective of outcome with regard to remission, and expected survival of more than 3 months. Fifty-seven participants were randomized to individualized follow-up and 55 patients to conventional follow-up. Well-being was measured at baseline and at 3, 6, 12, and 24 months after randomization for QoL (QLQ-C30 [European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire], QLQ-Ov28), the Hospital Anxiety and Depression Scale (HADS), and a Patient Satisfaction Questionnaire (PSQ-III). The primary endpoints were the effects of follow-up on each of the scores (via hierarchical mixed-effects model) and on relapse-free time (via Cox model). The total cost of follow-up was compared between each group. RESULTS There was evidence for a QoL and patient satisfaction benefit for individualized versus standard follow-up (QLQ-C30, P = 0.013; 95% confidence interval, -0.03 to -0.001; PSQ-III P = 0.002; 95% confidence interval, -0.003 to -0.015; QLQ-Ov28, P = 0.14). Hospital Anxiety and Depression Scale data provided no evidence in favor of either treatment (P = 0.42). Delivered to protocol individualized follow-up resulted in a delay in the presentation of symptomatic relapse (P = 0.04), although the effect on survival in this study is unknown. Cost was £700 lower on average for the individualized follow-up group, but the difference was not statistically significant at the 5% level (P = 0.07). CONCLUSIONS Individualized follow-up was superior to conventional follow-up in 3 of the 4 QoL and patient satisfaction surveys in this preliminary study. Further prospective studies are needed in a larger population.Trial registration number is ISRCTN59149551.
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Affiliation(s)
- Anne Lanceley
- *Department of Women's Cancer, The UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London; †Centre for Biostatistics, The University of Manchester, Manchester; ‡University College London Hospitals (UCLH) Gynaecological Cancer Centre; §Department of Applied Health Research, University College London; ‖Cancer Research UK and UCL Cancer Trials Centre, University College London, London, United Kingdom; and ¶University of New South Wales, Sydney, New South Wales, Australia
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22
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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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23
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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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24
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Beaver K, Williamson S, Sutton C, Hollingworth W, Gardner A, Allton B, Abdel-Aty M, Blackwood K, Burns S, Curwen D, Ghani R, Keating P, Murray S, Tomlinson A, Walker B, Willett M, Wood N, Martin-Hirsch P. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG 2016; 124:150-160. [PMID: 27062690 DOI: 10.1111/1471-0528.14000] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of nurse-led telephone follow-up (TFU) for patients with stage-I endometrial cancer. DESIGN Multicentre, randomised, non-inferiority trial. SETTING Five centres in the North West of England. SAMPLE A cohort of 259 women treated for stage-I endometrial cancer attending hospital outpatient clinics for routine follow-up. METHODS Participants were randomly allocated to receive traditional hospital based follow-up (HFU) or nurse-led TFU. MAIN OUTCOME MEASURES Primary outcomes were psychological morbidity (State Trait Anxiety Inventory, STAI-S) and patient satisfaction with the information provided. Secondary outcomes included patient satisfaction with service, quality of life, and time to detection of recurrence. RESULTS The STAI-S scores post-randomisation were similar between groups [mean (SD): TFU 33.0 (11.0); HFU 35.5 (13.0)]. The estimated between-group difference in STAI-S was 0.7 (95% confidence interval, 95% CI -1.9 to 3.3); the confidence interval lies above the non-inferiority limit (-3.5), indicating the non-inferiority of TFU. There was no significant difference between groups in reported satisfaction with information (odds ratio, OR 0.9; 95% CI 0.4-2.1; P = 0.83). Women in the HFU group were more likely to report being kept waiting for their appointment (P = 0.001), that they did not need any information (P = 0.003), and were less likely to report that the nurse knew about their particular case and situation (P = 0.005). CONCLUSIONS The TFU provides an effective alternative to HFU for patients with stage-I endometrial cancer, with no reported physical or psychological detriment. Patient satisfaction with information was high, with similar levels between groups. TWEETABLE ABSTRACT ENDCAT trial shows effectiveness of nurse-led telephone follow-up for patients with stage-I endometrial cancer.
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Affiliation(s)
- K Beaver
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - S Williamson
- School of Health Sciences, University of Central Lancashire, Preston, UK
| | - C Sutton
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - W Hollingworth
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - A Gardner
- Women's Health Research Department, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - B Allton
- Department of Obstetrics & Gynaecology, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - M Abdel-Aty
- Gynaecology Department, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK
| | - K Blackwood
- Women's Healthcare Unit, Wrightington, Wigan & Leigh NHS Foundation Trust, Hanover Diagnostic and Treatment Centre, Wigan, UK
| | - S Burns
- Women's Healthcare Unit, Wrightington, Wigan & Leigh NHS Foundation Trust, Hanover Diagnostic and Treatment Centre, Wigan, UK
| | - D Curwen
- Gynaecological Unit, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - R Ghani
- Department of Obstetrics & Gynaecology, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - P Keating
- Women's Health Directorate, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - S Murray
- Women's Health Directorate, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - A Tomlinson
- Corporate Cancer Team, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - B Walker
- Gynaecology Department, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK
| | - M Willett
- Gynaecology Department, East Lancashire Hospitals NHS Trust, Burnley General Hospital, Burnley, UK
| | - N Wood
- Women's Health Directorate, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - P Martin-Hirsch
- Women's Health Directorate, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
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Laios A, Gubbala K, Lampe R, Tolis A. Optimal MRI interval for detection of asymptomatic recurrence in surgically treated early cervical cancer by use of a mathematical model. Hippokratia 2016; 20:4-8. [PMID: 27895435 PMCID: PMC5074396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Applications of mathematical modeling may provide an insight into the timing of surveillance modalities. We aimed to determine the optimal magnetic resonance imaging (MRI) interval for the detection of surgically treated early cervical cancer asymptomatic recurrence by using a mathematical model for volumetric tumor growth time. METHODS We assumed that tumor volume increases by a factor equal to the basis of natural logarithms (e~2.718) at constant time intervals. Using a mathematical formula, the tumor volume (V) was converted to diameter (D), which could be expressed as a function of time (t), given an initial diameter Di (corresponding to initial volume Vi) and a constant DT, where DT is the time required for volumetric tumor growth by a factor (e). Three different DTs were used for demonstration of the model, i.e. 20, 100 and 400 days. RESULTS Assuming complete surgical clearance, a worst-case scenario for a 20-day DT indicated that a 20 μm cervical tumor would need at least 12 months to reach 10 mm in diameter, which would be detected with an annual surveillance interval MRI. Over a 5-year (60 months) follow-up, nearly five surveillance MRIs would be required if the threshold of 10 mm was desired. For a 100-day DT over a 5-year (60 months) follow-up, a single only MRI would be required, if the threshold of 10 mm was desired. In the case of an indolent tumor (DT is 400 days), the model would not recommend a surveillance MRI to detect asymptomatic recurrence. A positive linear association between optimal MRI intervals and volumetric tumor DTs was demonstrated. CONCLUSION In the absence of evidence, we postulate annual MRI scanning is probably the shortest interval, which can be clinically useful for optimization of routine surveillance follow-up protocols in surgically treated early cervical cancer. This mathematical model requires proper verification in prospective clinical studies. Hippokratia 2016, 20(1): 4-8.
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Affiliation(s)
- A Laios
- Gynecologic Oncology Firm, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Gubbala
- Gynecologic Oncology Firm, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - R Lampe
- Department of Obstetrics and Gynecology, University of Debrecen, Hungary
| | - A Tolis
- School of Mechanical Engineering, Sector of Industrial Management and Operational Research, National Technical University of Athens, Athens, Greece
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Compaci G, Rueter M, Lamy S, Oberic L, Recher C, Lapeyre-Mestre M, Laurent G, Despas F. Ambulatory Medical Assistance--After Cancer (AMA-AC): A model for an early trajectory survivorship survey of lymphoma patients treated with anthracycline-based chemotherapy. BMC Cancer 2015; 15:781. [PMID: 26498342 PMCID: PMC4619467 DOI: 10.1186/s12885-015-1815-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/16/2015] [Indexed: 12/21/2022] Open
Abstract
Background Cancer survivorship has emerged as an important aspect of oncology due to the possibility of physical and psychosocial complications. The purpose of this study was to assess the feasibility of the Ambulatory Medical Assistance for After Cancer (AMA-AC) procedure for monitoring lymphoma survivorship during the first year after chemotherapy. Methods AMA-AC is based on systematic general practitioner (GP) consultations and telephone interventions conducted by a nurse coordinator (NC) affiliated to the oncology unit, while an oncologist acts only on demand. Patients are regularly monitored for physical, psychological and social events, as well as their health-related quality of life (HRQoL). Inclusion criteria were patients newly diagnosed with non-Hodgkin or Hodgkin lymphomas, who had been treated with anthracycline-based chemotherapy and were in complete remission after treatment. Results All 115 patients and 113 collaborating GPs agreed to participate in the study. For patients who achieved one year of disease-free survival (n = 104) their assessments (438 in total) were fully completed. Eleven were excluded from analysis (9 relapses and 2 deaths). The most frequent complications when taking into account all grades were arthralgia (64.3 %) and infections (41.7 %). About one third of patients developed new diseases with cardiovascular complications as the most common. Psychological disorders such as anxiety, depression and post-traumatic stress disorder were diagnosed in 42.6 % of patients. The data collected showed that Hodgkin lymphoma patients, females, and patients with lower HRQoL (mental component) at study entry were at greater risk for developing at least one psychological disorder. Conclusion This study showed that AMA-AC is a feasible and efficient procedure for monitoring lymphoma survivorship in terms of GP and patient participation rates and adherence, and provides a high quality of operable data. Hence, the AMA-AC procedure may be transferable into clinical daily practice as an alternative to standard oncologist-based follow-up. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1815-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gisèle Compaci
- Department of Hematology - Internal Medicine, Toulouse University Hospital, Cancer University Institute of Toulouse Oncopole, Toulouse, France.
| | - Manuela Rueter
- INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France. .,Service of Medical and Clinical Pharmacology, Center of Pharmacovigilance, Pharmaco-epidemiology and Information on Drugs, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France.
| | - Sébastien Lamy
- INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France. .,Service of Medical and Clinical Pharmacology, Center of Pharmacovigilance, Pharmaco-epidemiology and Information on Drugs, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France. .,Department of Epidemiology, Health Economics and Public Health, Faculty of Medicine, University of Toulouse III Paul Sabatier, Toulouse, France.
| | - Lucie Oberic
- Department of Hematology - Internal Medicine, Toulouse University Hospital, Cancer University Institute of Toulouse Oncopole, Toulouse, France.
| | - Christian Recher
- Department of Hematology - Internal Medicine, Toulouse University Hospital, Cancer University Institute of Toulouse Oncopole, Toulouse, France. .,INSERM Unit 1037 (The French National Institute of Health and Medical Research), Center of Cancer Research, Toulouse, France.
| | - Maryse Lapeyre-Mestre
- INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France. .,Service of Medical and Clinical Pharmacology, Center of Pharmacovigilance, Pharmaco-epidemiology and Information on Drugs, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France. .,Laboratory of Medical and Clinical Pharmacology Faculty of Medicine, University III Paul Sabatier, Toulouse, France.
| | - Guy Laurent
- Department of Hematology - Internal Medicine, Toulouse University Hospital, Cancer University Institute of Toulouse Oncopole, Toulouse, France. .,INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France.
| | - Fabien Despas
- INSERM Unit 1027 (The French National Institute of Health and Medical Research), Faculty of Medicine, Toulouse, France. .,Service of Medical and Clinical Pharmacology, Center of Pharmacovigilance, Pharmaco-epidemiology and Information on Drugs, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France. .,Laboratory of Medical and Clinical Pharmacology Faculty of Medicine, University III Paul Sabatier, Toulouse, France.
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Abstract
ObjectiveThe main purpose of this article is to explore the current practice for follow-up of gynecological cancer, pointing out the different procedures, to determine the most clinically and cost-effective surveillance strategies after the primary treatment.Materials and MethodsWe analyzed the follow up strategies for ovarian, endometrial, and cervical cancer. All of the topics discussed below arose from the “ESGO State of Art Conference—Follow-up in gynaecological malignancies” in Turin, (September 11–13, 2014;http://torino2014.esgo.org/).ResultsPhysical but these practices should be integrated with biomarkers or imaging strategies. Currently, most recommendations about follow-up are based on retrospective studies and expert opinion, and there is some disagreement on surveillance strategies due to lack of evidence-based knowledge.ConclusionsAll surveillance procedures should be evidence-based with a clearly defined purpose: there is a need for prospective studies to compare the effectiveness of different follow-up regimens measuring overall survival, detection of recurrence, quality of life (QoL), and costs as outcomes.
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Gilbert A, Sebag-Montefiore D, Davidson S, Velikova G. Use of patient-reported outcomes to measure symptoms and health related quality of life in the clinic. Gynecol Oncol 2015; 136:429-39. [DOI: 10.1016/j.ygyno.2014.11.071] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 11/12/2022]
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Cox A, Faithfull S. Aiding a reassertion of self: a qualitative study of the views and experiences of women with ovarian cancer receiving long-term nurse-led telephone follow-up. Support Care Cancer 2015; 23:2357-64. [PMID: 25588575 DOI: 10.1007/s00520-014-2578-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study explored the views and experiences of women following treatment for ovarian cancer who had received long-term (at least 3 years) nurse-led telephone follow-up. Exploring the long-term experiences of follow-up for women with ovarian cancer provides important information regarding the coping processes of cancer survivors that can inform the development of innovative and patient-centred approaches of cancer follow-up. METHODS This is a qualitative study approach using interpretative phenomenological analysis (IPA). Eleven women were identified by a clinical nurse specialist as having received nurse-led telephone follow-up for a period of at least 3 years. These women were interviewed in person or over the telephone using a semi-structured interview schedule; interviews were audio-recorded and transcriptions were analysed using IPA. RESULTS Nurse-led telephone follow-up was felt to support a reassertion of self and a rejection of patient identity. Three core themes emerged regarding the positive impact of nurse-led telephone follow-up: 'Somebody was looking out for me' highlights the perception of increased psychosocial support; 'It's just reassurance' includes both the deep trust in the expertise of the nurse and the reassurance of the continued blood tests; and 'Time was never an issue' presents the perception of relaxed follow-up appointments with time to talk and the perceived practical benefits of this approach. CONCLUSIONS Nurse-led telephone follow-up was broadly recommended for women following treatment for ovarian cancer, particularly for those later on in the survivorship trajectory when focus may move from biomedical aspects of cure to holistic approaches to well-being. Remote interventions which provide a perception of a consistent and constant source of medical and psychosocial support may support adaption to cancer survivorship by enabling a reassertion of self and a rejection of patient identity.
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Affiliation(s)
- Anna Cox
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK,
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