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Original research
Ovarian cancer recurrence detection may not require in-person physical examination: an MSK team ovary study
  1. Jacqueline Feinberg1,
  2. Karen Carthew1,
  3. Emily Webster2,
  4. Kaity Chang1,
  5. Nita McNeil3,
  6. Dennis S Chi1,4,
  7. Kara Long Roche1,4,
  8. Ginger Gardner1,4,
  9. Oliver Zivanovic1,4 and
  10. Yukio Sonoda1,4
  1. 1Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2Department of Obstetrics and Gynecology, Yale-New Haven Hospital, New Haven, Connecticut, USA
  3. 3Quality & Safety Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  4. 4Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Yukio Sonoda, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY 10065, USA; sonoday{at}mskcc.org

Abstract

Objective Given the inconvenience and financial burden of frequent ovarian cancer surveillance and the risks of in-person visits due to COVID-19, which have led to the acceleration of telehealth adaptation, we sought to assess the role of in-person physical examination for the detection of ovarian cancer recurrence among patients enrolled in a routine surveillance program.

Methods This was a retrospective study of patients initially seen from January 2015 to December 2017 who experienced ovarian cancer recurrence during first clinical remission. Descriptive statistics and bivariate analyses were performed to compare differences in detection methods and in patient and disease characteristics.

Results Among 147 patients who met our inclusion criteria, there were no recurrences detected by physical examination alone. Forty-six (31%) patients had recurrence first detected by tumor marker, 81 (55%) by radiographic scan, 17 (12%) by presentation of new symptoms, and 3 (2%) by biopsies taken during non-oncological surgery. One hundred and eleven patients (75%) had multiple positive findings at the time of recurrence. Of all 147 patients, 48 (33%) had symptoms, 21 (14%) had physical examination findings, 106 (72%) had increases in tumor markers, and 141 (96%) had changes on imaging.

Conclusions In-person physical examination was not a primary means of detection for ovarian cancer recurrence for any patient. Substituting in-person visits for virtual visits that include patient-reported symptoms, alongside a regular surveillance protocol that includes tumor marker testing and imaging, may be a suitable approach for the detection of ovarian cancer recurrence while also reducing patient inconvenience and risks to health.

  • ovarian cancer

Data availability statement

Data are available upon reasonable request. Data will be made available upon reasonable request according to institutional processes.

https://doi.org/10.1136/ijgc-2021-002885

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    Data availability statement

    Data are available upon reasonable request. Data will be made available upon reasonable request according to institutional processes.

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    Footnotes

    • Twitter @jackiefeinberg

    • Contributors Conceptualization: YS, JF. Data curation: JF, KC, EW. Formal analysis: JF. Methodology: JF, YS. Project administration: KC, NM. Roles/Writing - original draft: JF. Writing - review & editing: all authors. Guarantor: YS.

    • Funding Funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

    • Competing interests Outside the submitted work, DSC reports personal fees from Bovie Medical Co. (now Apyx Medical), Verthermia, C Surgeries, and Biom ‘Up. DSC is also a former stockholder of Intuitive Surgical and TransEnterix. The other authors have no potential conflicts of interest to report.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.