Follow-up of patients who are clinically disease-free after primary treatment for fallopian tube, primary peritoneal, or epithelial ovarian cancer: a Program in Evidence-Based Care guideline adaptation.

T Le,J Dodge,E.B Kennedy,L Elit

doi:10.3747/co.23.3042

Abstract

A need for follow-up recommendations for survivors of fallopian tube, primary peritoneal, or epithelial ovarian cancer after completion of primary treatment was identified by Cancer Care Ontario's Program in Evidence-Based Care. We searched for existing guidelines, conducted a systematic review (medline, embase, and cdsr, January 2010 to March 2015), created draft recommendations, and completed a comprehensive review process. Outcomes included overall survival, quality of life, and patient preferences. The Cancer Australia guidance document Follow Up of Women with Epithelial Ovarian Cancer was adapted for the Ontario context. A key randomized controlled trial found that the overall survival rate did not differ between asymptomatic women who received early treatment based on elevated serum cancer antigen 125 (ca125) alone and women who waited for the appearance of clinical symptoms before initiating treatment (hazard ratio: 0.98; 95% confidence interval: 0.80 to 1.20; p = 0.85); in addition, patients in the delayed treatment group reported good global health scores for longer. No randomized studies were found for other types of follow-up. We recommend that survivors be made aware of the potential harms and benefits of surveillance, including a discussion of the limitations of ca125 testing. Women could be offered the option of no formal follow-up or a follow-up schedule that is agreed upon by the woman and her health care provider. Education about the most common symptoms of recurrence should be provided. Alternative models of care such as nurse-led or telephone-based follow-up (or both) could be emerging options. The recommendations provided in this guidance document have a limited evidence base. Recommendations should be updated as further information becomes available.

Highlights

In 2014, 2700 new cases of ovarian cancer and 1750 deaths from the disease were estimated to have occurred in Canada[1]
The Cancer Australia guidance document Follow Up of Women with Epithelial Ovarian Cancer was adapted for the Ontario context
We searched for existing English-language guidelines that were based on a systematic review and that addressed survival rate, quality of life, or level of anxiety associated with various follow-up intervals and methods for detection of recurrence in women with confirmation of remission after surgery and first-line chemotherapy for epithelial ovarian cancer

Summary

Introduction

In 2014, 2700 new cases of ovarian cancer and 1750 deaths from the disease were estimated to have occurred in Canada[1]. Over the past several decades, an improvement in 5-year survival has been observed, likely because of advances in surgical techniques and chemotherapeutic agents[2]; patients with ovarian cancer continue to have a lower rate of survival relative to many other cancer disease sites because diagnosis often occurs at an advanced stage. Managing the side effects of primary treatment, facilitating recruitment to clinical trials, or building a relationship between the patient and the oncology team in anticipation of a subsequent recurrence have been mentioned as additional reasons for follow-up. A need for follow-up recommendations for survivors of fallopian tube, primary peritoneal, or epithelial ovarian cancer after completion of primary treatment was identified by Cancer Care Ontario’s Program in Evidence-Based Care

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Conclusion