Abstract
In 2009, the Program in Evidence-based Care (pebc) of Cancer Care Ontario published a guideline on the follow-up of cervical cancer. In 2014, the pebc undertook an update of the systematic review and clinical practice guideline for women in this target population. The literature from 2007 to August 2014 was searched using medline and embase [extended to 2000 for studies of human papillomavirus (hpv) dna testing]. Outcomes of interest were measures of survival, diagnostic accuracy, and quality of life. A working group evaluated the need for changes to the earlier guidelines and incorporated comments and feedback from internal and external reviewers. One systematic review and six individual studies were included. The working group concluded that the new evidence did not warrant changes to the 2009 recommendations, although hpv dna testing was added as a potentially more sensitive method of detecting recurrence in patients treated with radiotherapy. Comments from internal and external reviewers were incorporated. Follow-up care after primary treatment should be conducted and coordinated by a physician experienced in the surveillance of cancer patients. A reasonable follow-up strategy involves visits every 3-4 months within the first 2 years, and every 6-12 months during years 3-5. Visits should include a patient history and complete physical examination, with elicitation of relevant symptoms. Vaginal vault cytology examination should not be performed more frequently than annually. Combined positron-emission tomography and computed tomography, other imaging, and biomarker evaluation are not advocated; hpv dna testing could be useful as a method of detection of recurrence after radiotherapy. General recommendations for follow-up after 5 years are also provided.
Highlights
580 new cases of, and 140 deaths from, cervical cancer occur in the province of Ontario each year1
Two systematic reviews authored by Meads et al.9,10 covered the role of pet-ct in detecting recurrence after complete response to treatment for cervical cancer
Cytology follow-up is not recommended for patients who have been treated with radiotherapy because, after treatment with radiotherapy, the accuracy of cervicovaginal cytology for cervical cancer is compromised by the anatomic and tissue changes resulting from irradiation17
Summary
580 new cases of, and 140 deaths from, cervical cancer occur in the province of Ontario each year. Most cases are diagnosed at International Federation of Gynecology and Obstetrics stage i or ii, and the 5-year survival rate for those women is high—that is, 80%–85%. In 2009, the Program in Evidence-Based Care (pebc) published a guideline for the follow-up of cervical cancer patients who had experienced complete response to treatment. The evidence base for that guideline was developed using a systematic review of follow-up methods and follow-up appointment frequency. In 2009, the Program in Evidence-based Care (pebc) of Cancer Care Ontario published a guideline on the follow-up of cervical cancer. In 2014, the pebc undertook an update of the systematic review and clinical practice guideline for women in this target population
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