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No Supportive Evidence for Clinical Benefit of Routine Follow-Up in Ovarian Cancer: A Dutch Multicenter Study
  1. Sandra M.E. Geurts, MSc*,
  2. Anne M. van Altena, MD,
  3. Femmie de Vegt, PhD*,
  4. Vivianne C.G. Tjan-Heijnen, MD, PhD,
  5. Leon F.A.G. Massuger, MD, PhD,
  6. Jos A.A.M. van Dijck, PhD* and
  7. André L.M. Verbeek*
  1. * Department of Epidemiology, Biostatistics, and HTA,
  2. Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen; and
  3. Division of Medical Oncology, Department of Internal Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
  1. Address correspondence and reprint requests to Sandra M.E. Geurts, MSc, Department of Epidemiology, Biostatistics, and HTA, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: S.Geurts{at}


Introduction: Routine follow-up is standard medical practice in ovarian cancer patients treated with curative intent. However, no strong evidence exists indicating that prognosis is improved. The objective of this study was to evaluate the routine follow-up schedule for ovarian cancer patients regarding the adherence to the Dutch protocol, the detection of recurrences, and the follow-up's impact on overall survival.

Methods: All 579 consecutive patients diagnosed with epithelial ovarian, primary peritoneal, or fallopian tube cancer in 4 Dutch hospitals between 1996 and 2006 were selected. Only patients in complete clinical remission after primary treatment were studied. Compliance to the Dutch follow-up guideline was assessed in a random sample of 68 patients. Of the 127 patients with recurrence, the mode of recurrence detection was addressed. Survival time since primary treatment was calculated using the Kaplan-Meier method.

Results: The patients received more follow-up visits than was recommended according to the guideline. The cumulative 5-year risk of recurrence was 55% (95% confidence interval [CI], 43%-67%). The survival of patients with recurrent ovarian cancer detected asymptomatically at a routine visit (n = 51) tended to be better compared with patients with symptomatic detection at a routine (n = 31) or diagnosed after an interval visit (n = 31). The median survival times were 44 (95% CI, 38-64), 29 (95% CI, 21-38), and 33 months (95% CI, 19-61), respectively (P = 0.08). The median time from primary treatment to recurrence was similar for the 3 groups: 14, 10, and 11 months, respectively (P = 0.26).

Conclusions: Follow-up in line with (inter)national guidelines yields a seemingly longer life expectancy if the recurrence was detected asymptomatically. However, this result is expected to be explained by differences in tumor biology and length-time bias.

  • Follow-up
  • Ovarian cancer
  • Recurrence
  • Survival

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