Abstract
A growing awareness of the harms of overtreatment in cancer care has reached physicians, patients, health policy makers, and medical researchers. Overtreatment exposes patients to the risk of adverse events from procedures or medications that were not necessary. This review examines common practices in gynecologic malignancies that are unlikely to produce direct benefit to patients with these malignancies, but are likely to produce harms. Specifically, we will explore the utility of lymphadenectomy and adjuvant radiation for women with early-stage endometrial cancer; and screening for recurrence and continuous chemotherapy for advanced-stage ovarian cancer patients.
Highlights
The development of practical quality care measures has become a priority within the US health-care system
Given the lack of evidence that surveillance using the level of Cancer antigen 125 (CA-125) present in blood samples prolongs survival, it is implausible that the early detection of recurrence through routine Computerized tomographic scans (CT) scanning could result in any significant increase in survival [40]
These clinical limitations of CT make magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging with their added expense and potentially increased false-positive rates challenging to justify in the asymptomatic ovarian cancer patient
Summary
The development of practical quality care measures has become a priority within the US health-care system. The goal of SLN mapping is to accurately identify lymph node metastases while saving patients from the morbidity of complete lymphadenectomy The utility of this technique as a strategy to reduce overtreatment has been firmly established in other disease sites (breast cancer and melanoma); the value and positive predictive value of SLN mapping in endometrial cancer has not been explored outside of single institution studies. Given the lack of evidence that surveillance using the level of CA-125 present in blood samples prolongs survival, it is implausible that the early detection of recurrence through routine CT scanning could result in any significant increase in survival [40] These clinical limitations of CT make magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging with their added expense and potentially increased false-positive rates challenging to justify in the asymptomatic ovarian cancer patient. No survival advantage was achieved for patients receiving chemotherapy administered by a medical oncologist [37]
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