Mode of detection of recurrent gynecological malignancy: Does routine follow-up delay diagnosis and treatment?

To investigate value of routine scheduled follow-up in detecting recurrent gynecological cancer, the National Group of Gynaecology NSSG Leads conducted a national prospective audit of the mode of detection of disease recurrence under the auspices of the Department of Health Cancer Services Collaborative. Two hundred fourteen responses were received from 16 of 34 cancer networks in England in addition to one center from Wales between August 2004 and October 2005. Only 42.5% of disease recurrences was detected at routine follow-up. Only 26.2% was diagnosed during an unscheduled (expedited) clinic appointment, while 19.2% was diagnosed by another professional group and 12.1% by "other" means (routine Ca125 or imaging). Only 77.1% of patients had symptoms at the time of detection of recurrent disease. Sixty-one patients (28.5%) complained of symptoms when they attended for routine scheduled follow-up. This data suggest that if these patients had recognized the significance of these symptoms and requested early clinic review, the diagnosis may have been expedited. Diagnosis of recurrence may be delayed for a significant proportion of women because they await a routine scheduled follow-up clinic attendance to report the development of symptoms. Patient-initiated follow-up may provide a more reactive and flexible model of care that encourages women to present as soon as symptoms are experienced. This model will be assessed in the UK in a large, multicenter, randomized controlled trial, Follow-up in Gynaecological cancer Units: Randomised controlled trial for Endometrium (FIGURE trial).