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Surveillance for ovarian carcinoma patients after curative-intent treatment.

5077 Background: Surveillance following initial curative-intent treatment for ovarian cancer is commonly done. The specific surveillance modalities used currently by clinicians, and how often they are recommended, are not known. We sought to determine the current surveillance practice patterns of clinical experts who treat patients with ovarian carcinoma.


METHODS
We employed a survey featuring vignettes describing 4 patients with ovarian carcinoma of different clinical stages and questions based on the vignettes. These were mailed to the 943 members of the Society of Gynecologic Oncologists (SGO). Those indicating that they performed surgery for ovarian cancer and also participated in long-term surveillance were asked to indicate how often they requested 11 discrete surveillance evaluations for their patients treated for cure in the first 10 posttreatment years. These included all those mentioned in the relevant literature. Descriptive statistics (mean, standard deviation, median, and range) were calculated.


RESULTS
Of the 943 SGO members surveyed, 323 (34%) responded; 283 (30%) were evaluable. The modalities most frequently recommended for each year were clinic visit, pelvic examination, and serum CA-125 level. There was marked variability in the recommended frequency of use. For example, the number of clinic visits recommended in postoperative year 1 for a patient with stage II ovarian carcinoma ranged from 2-12. The frequency of testing decreased with increasing postoperative years for all tests commonly recommended. For example, the median number of times a serum CA-125 level was recommended for a stage II patient was 4 during the first year, decreasing to 1 by year 5.


CONCLUSIONS
The details of current surveillance testing in patients treated for ovarian carcinoma have not been documented previously. There is little agreement in the literature about the most appropriate surveillance strategy. Ours are the first data on this topic, to our knowledge. Marked variability exists in the intensity of surveillance among SGO members. This 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.