How Do We Follow Up Patients With Endometrial Cancer?
- 106 Downloads
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.
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.
KeywordsEndometrial cancer Follow-up Post-treatment surveillance Recurrence, gynecologic malignancy
Compliance With Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 7.Agboola OO, Grunfeld E, Coyle D, Perry GA. Costs and benefits of routine follow-up after curative treatment for endometrial cancer. Can Med Assoc J. 1997;157:879–86.Google Scholar
- 38.•• 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(2):262–9. This study includes the largest historical cohort to date focused on recurrence detection in early-stage endometrial cancer. Important data on symptoms of recurrence and the effect of survival are presented, including a description of potential bias. Google Scholar
- 43.Park J-Y, Kim EN, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T, et al. Clinical impact of positron emission tomography or positron emission tomography/computed tomography in the posttherapy surveillance of endometrial carcinoma: evaluation of 88 patients. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2008;18:1332–8.CrossRefGoogle Scholar
- 53.•• Beaver K, Williamson S, Sutton C, Hollingworth W, Gardner A, Allton B, et al. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG. 2017;124:150–60. This is the first randomized trial on nurse-led telephone follow-up in early-stage endometrial cancer. No difference was reported in psychological morbidity, quality of life, or satisfaction compared with traditional follow-up. CrossRefGoogle Scholar
- 54.• Morrison V, Spencer LH, Totton N, Pye K, Yeo ST, Butterworth C, et al. Trial of Optimal Personalised Care After Treatment-Gynaecological Cancer (TOPCAT-G): a randomized feasibility trial. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2018;28:401–11. A protocol for a randomized trial on nurse-led telephone follow-up in gynecologic cancer is presented, and the study is reported to be feasible for a full-size intervention study with expected positive effects of the intervention on quality of life, well-being, and cost-benefit. CrossRefGoogle Scholar
- 55.•• Jeppesen MM, Jensen PT, Hansen DG, Christensen RD, Mogensen O. Patient-initiated follow up affects fear of recurrence and healthcare use: a randomised trial in early-stage endometrial cancer. BJOG Int J Obstet Gynaecol. 2018;125(13):1705–14. First randomized trial to examine patient-initiated follow-up in a population of early-stage endometrial cancer. Patient-initiated follow-up was feasible and reduced the use of health care, but fear of recurrence persisted longer compared with traditional follow-up. CrossRefGoogle Scholar
- 56.Schougaard LMV, Larsen LP, Jessen A, Sidenius P, Dorflinger L, de Thurah A, et al. AmbuFlex: tele-patient-reported outcomes (telePRO) as the basis for follow-up in chronic and malignant diseases. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2016;25:525–34.Google Scholar
- 67.Rappaport J, Seidman E, editors. Handbook of Community Psychology [Internet]. Springer US; 2000 [cited 2018 Jun 17]. Available from: www.springer.com/gp/book/9780306461606