A critical evaluation of current protocols for the follow-up of women treated for gynecological malignancies: A pilot study

This retrospective review was undertaken to determine the efficacy of routi ne follow-up in the detection and management of recurrent cancer. The case notes of all women attending a regional cancer center who were diagnosed wi th cancer in 1997 were reviewed. Of 81 new cancers followed up for a median of 42 months (range 36-48),14 have recurred after curative treatment and t here were six cases of persistent disease. The median number of clinic visi ts per patient was 3.5 (range 1-16). Eight recurrences (57.1%) were diagnos ed at scheduled outpatient appointments, three (21.4%) presented to the gen eral practitioner (GP), and three were seen as emergencies in hospital. Sev enteen patients with persistent/recurrent disease have died and three are a live with disease. The median time from initial presentation to disease rec urrence was 12 months (range 5-25) and the median time from recurrence to d eath was 5 months (range 1-20). The longest interval between onset of sympt oms and diagnosis of recurrence (4 months) occurred in those presenting at scheduled outpatient clinics. This study demonstrates that the current foll ow-up protocol is associated with delays in diagnosing recurrence, because symptomatic patients postpone seeking help until their scheduled visit. We have therefore commenced a prospective study evaluating other models of fol low-up.