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Follow up of women with epithelial ovarian cancer

Background

In 2004, National Breast Cancer Centre (NBCC)* and Australian Cancer Network (ACN) developed the Clinical practice guidelines for the management of women with epithelial ovarian cancer. Clinical practice guidelines are a key component of Cancer Australia’s leadership in information provision. Ensuring currency of guidelines is essential to ensuring timely, evidence-based information is available.

In September 2009, a meeting of the Ovarian Cancer Steering Committee was convened to identify and prioritise topic areas for revision within the guidelines. The selected topics were circulated among key stakeholders for further prioritisation. Three topics were identified for updating, including Follow-up for women with epithelial ovarian cancer. This updated chapter was developed for health professionals involved in the management of women after initial treatment for epithelial ovarian cancer.

A systematic review was undertaken by Cancer Australia of literature published between January 2003 and January 20101and informed the revision of this chapter, with input from a multidisciplinary working group. This chapter replaces information about follow-up (pages 127-129) in the Clinical practice guidelines for the management of women with epithelial ovarian cancer.

* In February 2008, National Breast Cancer Centre incorporating the Ovarian Cancer Program (NBCC) changed its name to National Breast and Ovarian Cancer Centre (NBOCC). On 30 June 2011, NBOCC amalgamated with Cancer Australia to form a single national agency, Cancer Australia

Epithelial ovarian cancer

Information in this chapter is limited to epithelial tumours, which account for approximately 84% of primary ovarian cancers, and represents the common usage of the term ‘ovarian cancer’.2The chapter does not include information about the follow-up for borderline tumours (also known as low malignant potential tumours). Borderline tumours are less common than invasive disease and include a number of different subtypes which behave differently.

For the majority of women treated for epithelial ovarian cancer, there is a high likelihood of recurrence;3 approximately 60-70% of patients will experience relapse.4 The median time to relapse ranges from 11 to 29 months.5 The risk of relapse is associated with the stage, histologic type and tumour grade.6 The pelvis and abdomen are the most common sites of recurrences.6

The median survival time for women with recurrent ovarian cancer ranges from 12 to 24 months.4 The longer the interval between treatments, the more likely the disease is to respond to re-treatment with the same drugs. The typical prognosis of recurrent ovarian cancer is increasingly shorter remissions, followed eventually by disease that is resistant to available chemotherapy agents.3

Follow-up post-treatment in women with epithelial ovarian cancer

Follow-up supports the physical and emotional needs of women following treatment.  There are a number of reasons for providing follow-up care to women post-treatment for epithelial ovarian cancer, including the identification of relapse and managing side effects of treatment.7 It can establish a conduit through which a woman can communicate with a health professional about her current health status, including issues such as menopausal symptoms, lymphoedema, fatigue, psychological issues, and the experience of the cancer journey. A definitive program is useful in providing this level of support.  Women with ovarian cancer expect such a program to offer continuity and support, regardless that the disease stage at diagnosis is predominantly advanced, and that the ultimate prognosis is usually poor.

While the optimal method of follow-up is not yet established, possible options for follow-up and the implications and possible consequences of these options, should be discussed with the woman at the completion of primary treatment. Some women will decide that the psychological trauma of follow-up is too unsettling and opt to attend follow-up visits only if they have symptoms. Some women may opt out of specialist follow-up. Others will be keen for surveillance – even though some may experience anxiety prior to the follow-up visits.8

Key point:

  • Reasons for providing follow-up care to women post-treatment for epithelial ovarian cancer include identification of relapse and managing side effects of treatment. Possible options for follow-up and their implications and consequences should be discussed with the woman prior to establishing the format and schedule of follow-up appointments.

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