Women should be offered the opportunity to have regular follow-up. Discussion with the woman about follow-up could incorporate a schedule of follow-up appointments, including the possibility of no formal follow-up schedule, based on the identified needs and wishes of the individual. A woman may be reviewed by either a gynaecological oncologist or medical oncologist. If it is convenient for the woman, she may see her gynaecological oncologist and medical oncologist at alternate visits. Communication with a woman s GP should be maintained throughout follow-up.14
There is no recommended frequency of follow-up consultations, but a clear and mutually agreed arrangement should be negotiated with the woman, tailored according to risk and to individual patient characteristics, which acknowledges the benefits of an ongoing relationship and the opportunity to deal with issues as they arise.
Women residing in rural and regional areas face additional challenges of access to specialist clinicians for follow-up appointments. Individual circumstances should be considered when establishing a follow-up schedule.
A common follow-up program reported in guidelines and publications in the systematic review is:11,15-20
- Review every three months for 2 years then;
- Review every four-six months for the next 2 years and;
- Review six monthly for a year before moving to annual review.
- It is important that a clear and mutually agreed care plan be offered to women who have been treated for epithelial ovarian cancer.
The basic format of consultation is to update the patient history, assess psychosocial and supportive care needs, and undertake physical examination, which may include pelvic examination. Studies have shown that the rates of recurrence detected through physical examination vary significantly. In a patient with symptoms or other reason to suspect recurrence, physical examination alone may not be sufficient.20,21
There should be time provided for the woman and her clinician to discuss the implications of monitoring progress and initiating treatment based on CA125 levels. Women can be advised that they have the option to have CA125 levels tested at agreed intervals, or not at all. Women who choose to have CA125 levels measured should be informed that CA125 levels may fluctuate due to individual and laboratory assay variations, and the implications of stable, fluctuating and rising levels should be discussed.
The woman s report to the clinician about how she feels will often contain the best index of recurrence for the clinician. Women should be encouraged to report a range of symptoms, including nausea, vomiting, abdominal distension, cramping pain and shortness of breath.16
Radiological imaging should not be done routinely, but should be performed if there is clinical or CA125 evidence of recurrence.21 The rationale for not undertaking routine imaging should be discussed with the woman.