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British Gynaecological Cancer Society recommendations and guidance on patient-initiated follow-up (PIFU)
  1. Claire Newton1,2,
  2. Andy Nordin3,
  3. Philip Rolland4,
  4. Thomas Ind5,
  5. Peter Larsen-Disney6,
  6. Pierre Martin-Hirsch7,
  7. Kinter Beaver8,
  8. Helen Bolton9,
  9. Richard Peevor10,
  10. Andrea Fernandes11,
  11. Fiona Kew12,
  12. Partha Sengupta13,
  13. Tracie Miles14,
  14. Lynn Buckley15,
  15. Helen Manderville16,
  16. Ketan Gajjar17,
  17. Jo Morrison18,
  18. Jonathan Ledermann19,
  19. Jonathan Frost20,
  20. Alexandra Lawrence21,
  21. Sudha Sundar22 and
  22. Christina Fotopoulou23,24
  1. 1 University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2 University of Bristol, Bristol, UK
  3. 3 East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
  4. 4 Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
  5. 5 Royal Marsden NHS Foundation Trust, London, UK
  6. 6 Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  7. 7 Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
  8. 8 University of Central Lancashire, Preston, UK
  9. 9 Addenbrooke's Hospital, London, UK
  10. 10 Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
  11. 11 Royal Marsden Hospital NHS Trust, London, UK
  12. 12 NHS Foundation Trust, Sheffield, UK
  13. 13 University Hospital of North Durham, Newcastle, Durham, UK
  14. 14 Royal United Hospital, Bath, UK
  15. 15 Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
  16. 16 Gateshead Health NHS Foundation Trust, Gateshead, UK
  17. 17 Nottingham University Hospitals NHS Trust, Nottingham, UK
  18. 18 Musgrove Park Hospital, Taunton, Somerset, UK
  19. 19 UCL Cancer Institute (NCRI/MRC), London, UK
  20. 20 Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
  21. 21 Barts Health NHS Trust, London, UK
  22. 22 University of Birmingham, Birmingham, Pennsylvania, UK
  23. 23 Imperial College London, London, UK
  24. 24 Queen Charlotte's and Chelsea Hospital, London, UK
  1. Correspondence to Claire Newton, Gynaecology Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU, UK; claire.newton{at}


The National Cancer Survivorship Initiative through the National Health Service (NHS) improvement in the UK started the implementation of stratified pathways of patient-initiated follow-up (PIFU) across various tumor types. Now the initiative is continued through the Living With and Beyond Cancer program by NHS England. Evidence from non-randomized studies and systematic reviews does not demonstrate a survival advantage to the long-established practice of hospital-based follow-up regimens, traditionally over 5 years. Evidence shows that patient needs are inadequately met under the traditional follow-up programs and there is therefore an urgent need to adapt pathways to the needs of patients. The assumption that hospital-based follow-up is able to detect cancer recurrences early and hence improve patient prognosis has not been validated. A recent survey demonstrates that follow-up practice across the UK varies widely, with telephone follow-up clinics, nurse-led clinics and PIFU becoming increasingly common. There are currently no completed randomized controlled trials in PIFU in gynecological malignancies, although there is a drive towards implementing PIFU. PIFU aims to individualize patient care, based on risk of recurrence and holistic needs, and optimizing resources. The British Gynaecological Cancer Society wishes to provide the gynecological oncology community with guidance and a recommendations statement regarding the value, indications, and limitations of PIFU in endometrial, cervical, ovarian, and vulvar cancers in an effort to standardize practice and improve patient care.

  • patient initiated follow-up (PIFU)
  • gynaecology oncology
  • follow-up (FU)
  • gynaecological malignancies

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  • Contributors All authors have contributed equally to the authorship.

  • Funding All costs relating to the BGCS guideline meeting on patient-initiated follow-up were covered by BGCS funds.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.