Abstract
We used decision analysis techniques with Markov cohort modeling to examine the role of cancer antigen 125 (CA-125) in follow-up surveillance strategies among patients with advanced ovarian cancer. Utilities were derived from a societal perspective.Using quality-adjusted life years (QALYS) as the outcome variable, the value of CA-125 monitoring for asymptomatic women with ovarian cancer was found to be reduced as compared with a strategy that includes CA-125 testing. Decisions to include CA-125 in surveillance strategies for ovarian cancer patients should be made after discussion with full disclosure of the preference-sensitive nature of CA-125. The model demonstrates that preferences and perspective can influence decisions in cancer care.
Highlights
Many authors have reported on the prognostic significance of the cancer antigen (CA-125) assay in ovarian cancer patients 1–3
A rising cancer antigen 125 (CA-125) level in a patient with clinical complete remission is highly predictive of a symptomatic recurrence, there is no evidence that immediate treatment with salvage chemotherapy is more effective than reserving such treatment until the time that other manifestations of recurrent disease appear 7–11
There is debate regarding whether asymptomatic patients with recurrence should be treated, and further, whether CA-125 monitoring should be a routine component of disease surveillance for women with ovarian cancer
Summary
Many authors have reported on the prognostic significance of the cancer antigen (CA-125) assay in ovarian cancer patients 1–3. The assay has become established in clinical practice, and it is widely used to monitor response to chemotherapy, including chemotherapy given in the recurrent setting 4,5. It has been used in many academic centres to facilitate early diagnosis of relapse 6. There is debate regarding whether asymptomatic patients with recurrence should be treated, and further, whether CA-125 monitoring should be a routine component of disease surveillance for women with ovarian cancer. It has been suggested that, until proof has been developed that early recognition and treatment of relapse improves patient outcomes, routine measurement of CA-125 for disease surveillance be abandoned 13
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