New Posttreatment Guidelines for Gynecologic Cancers Developed

Clinical observations are more effective than routine testing in posttreatment surveillance and diagnosis of most gynecologic tumors, according to new recommendations from the Society of Gynecologic Oncology (SGO).

The SGO’s Clinical Practice Committee, whose findings are detailed in this month’s American Journal of Obstetrics & Gynecology, found that there is not enough evidence to establish that routine cytologic testing and radiographic imaging in particular are cost-effective methods of monitoring women for disease recurrence.

Instead, the recommendations stress that physicians should gather a thorough history, perform a physical examination, and educate patients about symptoms. In addition, the panel emphasized the need to educate primary care physicians about follow-up procedures because many women typically return to those providers 2 years after treatment.

The paper includes detailed surveillance techniques and appropriate monitoring intervals for endometrial, ovarian, nonepithelial ovarian, cervical, vulvar, and vaginal cancers. The panel also developed a checklist for surveillance of gynecologic malignancies.

Investigators noted the need to determine optimal care for gynecologic cancer survivors because their numbers are rising and care is expensive.

Ritu Salani, MD, MBA

“The recommendations for surveillance are designed to continue to offer women who have completed treatment for gynecologic malignancies with high-quality care, while eliminating unnecessary tests,” lead author Ritu Salani, MD, MBA, assistant professor, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine in Columbus, said in an interview.

“Particularly as more women are long-term survivors of gynecologic cancers, educating primary care physicians is of critical importance,” she said. “This will not only benefit patient care, but also brings attention to cost-effective behavior.”

An estimated 80,000 women were diagnosed with gynecologic cancers in the United States last year and these malignancies account for 20% of all women cancer survivors, the SGO said.

There is a pressing need for prospective studies to determine the most cost-effective methods of detecting recurrence in patients who have achieved a complete response, but the review panel indicated that existing evidence suggests a poor cost-benefit result.

For example, one study indicated that vaginal cytologic evaluation alone detected only 3 of 44 recurrences (7%), while another analysis found that the use of this evaluation method at each visit cost $27,000 per case detected.

Salani said testing costs vary in different areas of the country, noting vaginal cytology in Columbus costs about $70 for the test itself, not including nursing and follow-up expenses. “Cytology adds little, if any benefit, for follow-up care and it is neither clinically— or cost-effective,” she said.

She said the panel’s report is the first paper on posttreatment surveillance from the SGO, but that updates are likely as information continues to evolve and new tests are developed.

Salani R, Backes FJ, Fung MF, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol. 2011;204[6]:466-478.