Patient-initiated follow-up in low-risk endometrial cancer after surgery: a systematic review

To evaluate the impact of patient-initiated follow-up in surgically treated early-stage endometrial cancer on quality of life, survival, and health care costs in patients with low-risk early-stage endometrial cancer.

We searched the Cochrane Centre Register of Controlled trials, MEDLINE, Embase, LILACS, and CINAHL databases up to August 24, 2024. Inclusion criteria were randomized controlled trials, cohort studies, and observational studies that included women aged >18 years with stage 1A, grade 1 and 2 endometrial cancers, as per the International Federation of Gynecology and Obstetrics 2009 staging criteria, who underwent surgery as their primary treatment and did not require adjuvant therapy. Included studies were those that assessed the impact of patient-initiated follow-up in low-risk endometrial cancer. The primary outcome was quality of life. The secondary outcomes were overall survival, cancer-specific survival, recurrence-free survival, cost/health care utilization, and adverse events. Data were extracted and the evidence were synthesized.

A total of 6 studies with a total of 1081 participants matched the selection criteria and were included. There was 1 multi-center randomized controlled trial and 5 cohort studies. Patient-initiated follow-up had no impact on fear of cancer recurrence in 1 study, and the quality of life, assessed in 2 studies, was acceptable. In 5 studies that included 853 patients and a median follow-up between 10 and 60.7 months, there were 22 recurrences and the overall survival was 93% to100%.

Patient-initiated follow-up may be a viable mode of surveillance for patients with low-risk endometrial cancer and appears to have little impact on quality of life. Evidence for the impact of patient-initiated follow-up on survival on this patient population is lacking. Large, randomized controlled trials are needed to assess long-term outcomes.