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How Do We Follow Up Patients With Endometrial Cancer?

  • Gynecologic Cancers (NS Reed, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In this review, we present the existing evidence regarding follow-up care after endometrial cancer, including content of follow-up and type of provider. We furthermore discuss the future perspectives for follow-up care and research in the field.

Recent Findings

Recently published randomized controlled trials show that nurse-led telephone follow-up and patient-initiated follow-up are feasible alternatives to routine hospital-based follow-up.

Summary

No randomized or prospective study has evaluated the effect of routine follow-up on survival. Hence, current knowledge is derived from retrospective studies with the inherent risk of bias. The most important method for recurrence detection is a review of symptoms. There is no evidence to support a survival benefit from the use of routine physical examinations, additional tests, or imaging. One in three of the women attending hospital-based follow-up experience unmet needs, and alternative models for follow-up focused on survivorship care and empowerment should be tested.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  Google Scholar 

  2. Shisler R, Sinnott JA, Wang V, Hebert C, Salani R, Felix AS. Life after endometrial cancer: a systematic review of patient-reported outcomes. Gynecol Oncol. 2018;148:403–13.

    Article  Google Scholar 

  3. Grunfeld E, Earle CC. The interface between primary and oncology specialty care: treatment through survivorship. J Natl Cancer Inst Monogr. 2010;2010:25–30.

    Article  Google Scholar 

  4. Leeson SC, Beaver K, Ezendam NPM, Mačuks R, Martin-Hirsch PL, Miles T, et al. The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials. Eur J Obstet Gynecol Reprod Biol. 2017;210:376–80.

    Article  CAS  Google Scholar 

  5. Lajer H, Jensen MB, Kilsmark J, Albæk J, Svane D, Mirza MR, et al. The value of gynecologic cancer follow-up: evidence-based ignorance? Int J Gynecol Cancer. 2010;20:1307–20.

    PubMed  Google Scholar 

  6. Fung-Kee-Fung M, Dodge J, Elit L, Lukka H, Chambers A, Oliver T, et al. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecol Oncol. 2006;101:520–9.

    Article  Google Scholar 

  7. Agboola OO, Grunfeld E, Coyle D, Perry GA. Costs and benefits of routine follow-up after curative treatment for endometrial cancer. Can Med Assoc J. 1997;157:879–86.

    CAS  Google Scholar 

  8. Sartori E, Pasinetti B, Carrara L, Gambino A, Odicino F, Pecorelli S. Pattern of failure and value of follow-up procedures in endometrial and cervical cancer patients. Gynecol Oncol. 2007;107:S241–7.

    Article  CAS  Google Scholar 

  9. Zola P, Macchi C, Cibula D, Colombo N, Kimmig R, Maggino T, et al. Follow-up in gynecological malignancies: a state of art. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2015;25:1151–64.

    Article  Google Scholar 

  10. Vistad I, Moy BW, Salvesen HB, Liavaag AH. Follow-up routines in gynecological cancer - time for a change? Acta Obstet Gynecol Scand. 2011;90:707–18.

    Article  Google Scholar 

  11. Sartori E, Pasinetti B, Chiudinelli F, Gadducci A, Landoni F, Maggino T, et al. Surveillance procedures for patients treated for endometrial cancer: a review of the literature. Int J Gynecol Cancer. 2010;20:985–92.

    Article  Google Scholar 

  12. Jones JM, Ferguson S, Edwards E, Walton T, McCurdy N, Howell D. Experiences of care delivery: endometrial cancer survivors at end of treatment. Gynecol Oncol. 2012;124:458–64.

    Article  Google Scholar 

  13. Ueda Y, Enomoto T, Egawa-Takata T, Miyatake T, Yoshino K, Fujita M, et al. Endometrial carcinoma: better prognosis for asymptomatic recurrences than for symptomatic cases found by routine follow-up. Int J Clin Oncol. 2010;15:406–12.

    Article  Google Scholar 

  14. Berchuck A, Anspach C, Evans AC, Soper JT, Rodriguez GC, Dodge R, et al. Postsurgical surveillance of patients with FIGO stage I/II endometrial adenocarcinoma. Gynecol Oncol. 1995;59:20–4.

    Article  CAS  Google Scholar 

  15. Bristow RE, Purinton SC, Santillan A, Diaz-Montes TP, Gardner GJ, Giuntoli RL. Cost-effectiveness of routine vaginal cytology for endometrial cancer surveillance. Gynecol Oncol. 2006;103:709–13.

    Article  Google Scholar 

  16. Carrara L, Gadducci A, Landoni F, Maggino T, Scambia G, Galletto L, et al. Could different follow-up modalities play a role in the diagnosis of asymptomatic endometrial cancer relapses?: an Italian multicentric retrospective analysis. Int J Gynecol Cancer. 2012;22:1013–9.

    Article  Google Scholar 

  17. Cooper AL, Dornfeld-Finke JM, Banks HW, Davey DD, Modesitt SC. Is cytologic screening an effective surveillance method for detection of vaginal recurrence of uterine cancer? Obstet Gynecol. 2006;107:71–6.

    Article  Google Scholar 

  18. Gordon AF, Owen P, Chien PF, Duncan ID. A critical evaluation of follow-up of women treated for endometrial adenocarcinoma. J Obstet Gynaecol. 1997;17:386–9.

    Article  CAS  Google Scholar 

  19. Morice P, Levy-Piedbois C, Ajaj S, Pautier P, Haie-Meder C, Lhomme C, et al. Value and cost evaluation of routine follow-up for patients with clinical stage I/II endometrial cancer. Eur J Cancer. 2001;37:985–90.

    Article  CAS  Google Scholar 

  20. Ng TY, Ngan HY, Cheng DK, Wong LC. Vaginal vault cytology in the routine follow-up of patients treated for endometrial carcinoma: is it useful? Aust N Z J Obstet Gynaecol. 1997;37:104–6.

    Article  CAS  Google Scholar 

  21. Olaitan A, Murdoch J, Anderson R, James J, Graham J, Barley V. A critical evaluation of current protocols for the follow-up of women treated for gynecological malignancies: a pilot study. Int J Gynecol Cancer. 2001;11:349–53.

    Article  CAS  Google Scholar 

  22. Podczaski E, Kaminski P, Gurski K, MacNeill C, Stryker JA, Singapuri K, et al. Detection and patterns of treatment failure in 300 consecutive cases of “early” endometrial cancer after primary surgery. Gynecol Oncol. 1992;47:323–7.

    Article  CAS  Google Scholar 

  23. Reddoch JM, Burke TW, Morris M, Tornos C, Levenback C, Gershenson DM. Surveillance for recurrent endometrial carcinoma: development of a follow-up scheme. Gynecol Oncol. 1995;59:221–5.

    Article  CAS  Google Scholar 

  24. Salvesen HB, Akslen LA, Iversen T, Iversen OE. Recurrence of endometrial carcinoma and the value of routine follow up. Br J Obstet Gynaecol. 1997;104:1302–7.

    Article  CAS  Google Scholar 

  25. Shumsky AG, Stuart GCE, Brasher PM, Nation JG, Robertson DI, Sangkarat S. An evaluation of routine follow-up of patients treated for endometrial carcinoma. Gynecol Oncol. 1994;55:229–33.

    Article  CAS  Google Scholar 

  26. Smith CJ, Heeren M, Nicklin JL, Perrin LC, Land R, Crandon AJ, et al. Efficacy of routine follow-up in patients with recurrent uterine cancer. Gynecol Oncol. 2007;107:124–9.

    Article  Google Scholar 

  27. Owen P, Duncan ID. Is there any value in the long term follow up of women treated for endometrial cancer? Br J Obstet Gynaecol. 1996;103:710–3.

    Article  CAS  Google Scholar 

  28. Gadducci A, Cosio S, Fanucchi A, Cristofani R, Genazzani AR. An intensive follow-up does not change survival of patients with clinical stage I endometrial cancer. Anticancer Res. 2000;20:1977–84.

    CAS  PubMed  Google Scholar 

  29. Allsop JR, Preston J, Crocker S. Is there any value in the long-term follow up of women treated for endometrial cancer? Br J Obstet Gynaecol. 1997;104:122.

    Article  CAS  Google Scholar 

  30. Macdonald J, Kidd G. An audit of endometrial carcinoma: the value of routine follow up. J Obstet Gynaecol. 2009;10:548–50.

    Article  Google Scholar 

  31. Yoshiba T, Takei Y, Machida S, Taneichi A, Sato N, Takahashi S, et al. Prognosis of endometrial cancer patients with and without symptoms at recurrence. J Obstet Gynaecol Res. 2016;42:1814–21.

    Article  Google Scholar 

  32. Aung L, Howells REJ, Lim KCK, Hudson E, Jones PW. Why routine clinical follow-up for patients with early stage endometrial cancer is not always necessary: a study on women in South Wales. Int J Gynecol Cancer. 2014;24:556–63.

    Article  Google Scholar 

  33. Kiran G, Kesterson JP, Ozerkan K, Kanis M, Groman A, Lele S. Evaluation of the outcome benefit conferred by intensive surveillance strategies in women with early-stage endometrial cancer. Eur J Gynaecol Oncol. 2013;34:522–6.

    CAS  PubMed  Google Scholar 

  34. Nordin AJ, National Group of Gynaecology NSSG Leads. Mode of detection of recurrent gynecological malignancy: does routine follow-up delay diagnosis and treatment? Int J Gynecol Cancer. 2006;16:1746–8.

    Article  CAS  Google Scholar 

  35. Hunn J, Tenney ME, Tergas AI, Bishop EA, Moore K, Watkin W, et al. Patterns and utility of routine surveillance in high grade endometrial cancer. Gynecol Oncol. 2015;137:485–9.

    Article  Google Scholar 

  36. Salani R, Nagel CI, Drennen E, Bristow RE. Recurrence patterns and surveillance for patients with early stage endometrial cancer. Gynecol Oncol. 2011;123:205–7.

    Article  Google Scholar 

  37. Zakhour M, Li AJ, Walsh CS, Cass I, Karlan BY, Rimel BJ. Post treatment surveillance of type II endometrial cancer patients. Gynecol Oncol. 2013;131:609–12.

    Article  Google Scholar 

  38. •• Jeppesen MM, Mogensen O, Hansen DG, Iachina M, Korsholm M, Jensen PT. Detection of recurrence in early stage endometrial cancer - the role of symptoms and routine follow-up. Acta Oncol. 2017;56(2):262–9. This study includes the largest historical cohort to date focused on recurrence detection in early-stage endometrial cancer. Important data on symptoms of recurrence and the effect of survival are presented, including a description of potential bias.

  39. Tjalma WAA, van Dam PA, Makar AP, Cruickshank DJ. The clinical value and the cost-effectiveness of follow-up in endometrial cancer patients. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2004;14:931–7.

    Article  CAS  Google Scholar 

  40. Lawrence G, Wallis M, Allgood P, Nagtegaal ID, Warwick J, Cafferty FH, et al. Population estimates of survival in women with screen-detected and symptomatic breast cancer taking account of lead time and length bias. Breast Cancer Res Treat. 2009;116:179–85.

    Article  Google Scholar 

  41. Duffy SW, Nagtegaal ID, Wallis M, Cafferty FH, Houssami N, Warwick J, et al. Correcting for lead time and length bias in estimating the effect of screen detection on cancer survival. Am J Epidemiol. 2008;168:98–104.

    Article  Google Scholar 

  42. Salani R, Khanna N, Frimer M, Bristow RE, Chen L-M. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecol Oncol. 2017;146:3–10.

    Article  Google Scholar 

  43. Park J-Y, Kim EN, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T, et al. Clinical impact of positron emission tomography or positron emission tomography/computed tomography in the posttherapy surveillance of endometrial carcinoma: evaluation of 88 patients. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2008;18:1332–8.

    Article  Google Scholar 

  44. Grunfeld E, Mant D, Yudkin P, Adewuyi-Dalton R, Cole D, Stewart J, et al. Routine follow up of breast cancer in primary care: randomised trial. BMJ. 1996;313:665–9.

    Article  CAS  Google Scholar 

  45. Grunfeld E, Fitzpatrick R, Mant D, Yudkin P, Adewuyi-Dalton R, Stewart J, et al. Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: results from a randomized controlled trial. Br J Gen Pract. 1999;49:705–10.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Grunfeld E, Levine MN, Julian JA, Coyle D, Szechtman B, Mirsky D, et al. Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care. J Clin Oncol. 2006;24:848–55.

    Article  Google Scholar 

  47. Wattchow DA, Weller DP, Esterman A, Pilotto LS, McGorm K, Hammett Z, et al. General practice vs surgical-based follow-up for patients with colon cancer: randomised controlled trial. Br J Cancer. 2006;94:1116–21.

    Article  CAS  Google Scholar 

  48. Augestad KM, Norum J, Dehof S, Aspevik R, Ringberg U, Nestvold T, et al. Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial. BMJ Open. 2013;3:e002391.

    Article  Google Scholar 

  49. Beaver K, Tysver-Robinson D, Campbell M, Twomey M, Williamson S, Hindley A, et al. Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial. BMJ. 2009;338:a3147.

    Article  Google Scholar 

  50. Beaver K, Campbell M, Williamson S, Procter D, Sheridan J, Heath J, et al. An exploratory randomized controlled trial comparing telephone and hospital follow-up after treatment for colorectal cancer. Color Dis. 2012;14:1201–9.

    Article  CAS  Google Scholar 

  51. Kimman ML, Dirksen CD, Voogd AC, Falger P, Gijsen BCM, Thuring M, et al. Nurse-led telephone follow-up and an educational group programme after breast cancer treatment: results of a 2 × 2 randomised controlled trial. Eur J Cancer. 2011;47:1027–36.

    Article  CAS  Google Scholar 

  52. Strand E, Nygren I, Bergkvist L, Smedh K. Nurse or surgeon follow-up after rectal cancer: a randomized trial. Color Dis. 2011;13:999–1003.

    Article  CAS  Google Scholar 

  53. •• Beaver K, Williamson S, Sutton C, Hollingworth W, Gardner A, Allton B, et al. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG. 2017;124:150–60. This is the first randomized trial on nurse-led telephone follow-up in early-stage endometrial cancer. No difference was reported in psychological morbidity, quality of life, or satisfaction compared with traditional follow-up.

    Article  CAS  Google Scholar 

  54. • Morrison V, Spencer LH, Totton N, Pye K, Yeo ST, Butterworth C, et al. Trial of Optimal Personalised Care After Treatment-Gynaecological Cancer (TOPCAT-G): a randomized feasibility trial. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2018;28:401–11. A protocol for a randomized trial on nurse-led telephone follow-up in gynecologic cancer is presented, and the study is reported to be feasible for a full-size intervention study with expected positive effects of the intervention on quality of life, well-being, and cost-benefit.

    Article  Google Scholar 

  55. •• Jeppesen MM, Jensen PT, Hansen DG, Christensen RD, Mogensen O. Patient-initiated follow up affects fear of recurrence and healthcare use: a randomised trial in early-stage endometrial cancer. BJOG Int J Obstet Gynaecol. 2018;125(13):1705–14. First randomized trial to examine patient-initiated follow-up in a population of early-stage endometrial cancer. Patient-initiated follow-up was feasible and reduced the use of health care, but fear of recurrence persisted longer compared with traditional follow-up.

    Article  CAS  Google Scholar 

  56. Schougaard LMV, Larsen LP, Jessen A, Sidenius P, Dorflinger L, de Thurah A, et al. AmbuFlex: tele-patient-reported outcomes (telePRO) as the basis for follow-up in chronic and malignant diseases. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2016;25:525–34.

    Google Scholar 

  57. Oshima S, Kisa K, Terashita T, Habara M, Kawabata H, Maezawa M. A qualitative study of Japanese patients’ perspectives on post-treatment care for gynecological cancer. Asian Pac J Cancer Prev. 2011;12:2255–61.

    CAS  PubMed  Google Scholar 

  58. Beesley V, Eakin E, Steginga S, Aitken J, Dunn J, Battistutta D. Unmet needs of gynaecological cancer survivors: implications for developing community support services. Psychooncology. 2008;17:392–400.

    Article  Google Scholar 

  59. Savard J, Ivers H. The evolution of fear of cancer recurrence during the cancer care trajectory and its relationship with cancer characteristics. J Psychosom Res. 2013;74:354–60.

    Article  Google Scholar 

  60. Lebel S, Tomei C, Feldstain A, Beattie S, McCallum M. Does fear of cancer recurrence predict cancer survivors’ health care use? Support Care Cancer. 2013;21:901–6.

    Article  Google Scholar 

  61. Ozga M, Aghajanian C, Myers-Virtue S, McDonnell G, Jhanwar S, Hichenberg S, et al. A systematic review of ovarian cancer and fear of recurrence. Palliat Support Care. 2015;13:1771–80.

    Article  Google Scholar 

  62. van de Wal M, van de Poll-Franse L, Prins J, Gielissen M. Does fear of cancer recurrence differ between cancer types? A study from the population-based PROFILES registry. Psychooncology. 2016;25:772–8.

    Article  Google Scholar 

  63. Bradley EJ, Pitts MK, Redman CWE, Calvert E. The experience of long-term hospital follow-up for women who have suffered early stage gynecological cancer: a qualitative interview study. Int J Gynecol Cancer. 1999;9:491–6.

    Article  Google Scholar 

  64. Greimel E, Lahousen M, Dorfer M, Lambauer M, Lang U. Patients’ view of routine follow-up after gynecological cancer treatment. Eur J Obstet Gynecol Reprod Biol. 2011;159:180–3.

    Article  Google Scholar 

  65. Hodgkinson K, Butow P, Fuchs A, Hunt GE, Stenlake A, Hobbs KM, et al. Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes. Gynecol Oncol. 2007;104:381–9.

    Article  Google Scholar 

  66. Rappapon J. Studies in empowerment. Prev Hum Serv. 1984;3:1–7.

    Article  Google Scholar 

  67. Rappaport J, Seidman E, editors. Handbook of Community Psychology [Internet]. Springer US; 2000 [cited 2018 Jun 17]. Available from: www.springer.com/gp/book/9780306461606

  68. Jørgensen CR, Thomsen TG, Ross L, Dietz SM, Therkildsen S, Groenvold M, et al. What facilitates “patient empowerment” in cancer patients during follow-up: a qualitative systematic review of the literature. Qual Health Res. 2018;28:292–304.

    Article  Google Scholar 

  69. Holm LV, Hansen DG, Larsen PV, Johansen C, Vedsted P, Bergholdt SH, et al. Social inequality in cancer rehabilitation: a population-based cohort study. Acta Oncol Stockh Swed. 2013;52:410–22.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Lillebaelt Hospital, Kolding, Sygehusvej 24, 6000, Kolding, Denmark

    Mette Moustgaard Jeppesen

  2. Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Ole Mogensen & Pernille T. Jensen

  3. Faculty of Health, Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark

    Ole Mogensen & Pernille T. Jensen

  4. Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J. B. Winsløws vej 9A, 5000, Odense C, Denmark

    Dorte G. Hansen

  5. Department of Gynecology and Obstetrics, Odense University Hospital, Sdr Boulevard, J.B. Winsløws vej 4, 5000, Odense C, Denmark

    Stinne H. Bergholdt

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  1. Mette Moustgaard Jeppesen
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  2. Ole Mogensen
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Correspondence to Mette Moustgaard Jeppesen.

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Jeppesen, M.M., Mogensen, O., Hansen, D.G. et al. How Do We Follow Up Patients With Endometrial Cancer?. Curr Oncol Rep 21, 57 (2019). https://doi.org/10.1007/s11912-019-0805-3

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