217358 Patient surveillance after potentially curative treatment for ovarian cancer

Tuesday, November 9, 2010 : 12:45 PM - 1:00 PM

Garo Harmandayan, BS , Department of Surgery, Saint Louis University, Saint Louis, MO
Katherine Virgo, PhD, MBA , Director, Health Services Research/ Surveillance & Health Policy Research Dept., American Cancer Society, Atlanta, GA
Feng Gao, PhD , Division of Biostatistics, Washington University, Saint Louis, MO
David Mutch, MD , Department of Obstetrics and Gynecology, Washington University School of Medicine, St.Louis, MO
Frank E. Johnson, MD , Department of Surgery, Saint Louis University, St. Louis, MO
Introduction: Patient surveillance after initial curative-intent treatment for ovarian carcinoma has important clinical, legal, and financial implications for patients, physicians, and society. The particular modalities used in surveillance by clinicians, and how frequently they are recommended, are not known at present. We sought to determine the current follow-up practice patterns of highly credentialed experts who treat patients with ovarian cancer and also provide care for them after initial treatment. Materials and Methods: We devised a survey featuring vignettes describing 4 patients with ovarian carcinoma of different clinical stages and questions based on the vignettes. Surveys were mailed to the 943 members of the Society of Gynecologic Oncologists (SGO). The survey requested demographic data. Those indicating that they performed ovarian cancer surgery and also participated in long-term follow-up care were asked how often they requested 11 discrete follow-up evaluations for their patients treated for cure in the first ten post-operative years. These 11 modalities include all those mentioned in the relevant medical literature. Simple descriptive statistics (mean, standard deviation, median, and range) were calculated. Results: Of the 943 gynecologic oncologists surveyed, 323 (34%) responded; 283 (30%) were evaluable. The most frequently recommended modalities for each year were office visit, pelvic examination and serum CA-125 level. There was marked variability in the recommended frequency of their use. For example, the number of office visits recommended in post-operative year 1 for a patient with stage III ovarian carcinoma with > 1 cm of residual tumor after surgery ranged from 2-12. No imaging studies were frequently recommended. The frequency of testing decreased with increasing post-operative years for all tests that were commonly recommended. For example, the median number of times the serum CA-125 level was recommended for a high-risk stage III patient was 4 during the first year, decreasing to 1 by year 5. Conclusion: The details of current surveillance testing in patients treated for ovarian cancer have not been documented previously. There is little agreement in the literature about the most appropriate surveillance strategy. Ours is the first data on this topic, to our knowledge. There is marked variability in the intensity of surveillance among SGO members, which is prima facie evidence of overuse and/or underuse and/or misuse of scarce medical resources. Further research should aim to identify the sources of this variability.

Learning Areas:
Clinical medicine applied in public health
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related research

Learning Objectives:
Discuss the importance of post-operative surveillance testing of patient with ovarian cancer. Identify the lack of high quality evidence supporting any particular postoperative surveillance strategy. Learn how expert clinicians carry out surveillance in patients with ovarian cancer after curative-intent initial treatment. Discuss the variation in practices among expert clinicians. Develop a strategy for surveillance of ovarian cancer patients after curative-intent treatment.

Keywords: Surveillance, Cancer

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None

Qualified on the content I am responsible for because: I am the principal investigator on this research topic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.