Gynaecological cancer follow-up: national survey of current practice in the UK

OBJECTIVE: To establish a baseline of national practice for follow-up after treatment for gynaecological cancer. DESIGN: Questionnaire survey. SETTING: Gynaecological cancer centres and units. GEOGRAPHICAL LOCATION: UK. PARTICIPANTS: Members of the British Gynaecological Cancer Society and the National Forum of Gynaecological Oncology Nurses. INTERVENTIONS: A questionnaire survey. OUTCOME MEASURES: To determine schedules of follow-up, who provides it and what routine testing is used for patients who have had previous gynaecological cancer. RESULTS: A total of 117 responses were obtained; 115 (98%) reported hospital scheduled regular follow-up appointments. Two involved general practitioners. Follow-up was augmented or replaced by telephone follow-up in 29 responses (25%) and patient-initiated appointments in 38 responses (32%). A total of 80 (68%) cancer specialists also offered combined follow-up clinics with other specialties. Clinical examinations for hospital-based follow-up were mainly performed by doctors (67% for scheduled regular appointments and 63% for patient-initiated appointments) while telephone follow-up was provided in the majority by nurses (76%). Most respondents (76/117 (65%)) provided routine tests, of which 66/76 (87%) reported carrying out surveillance tests for ovarian cancer, 35/76 (46%) for cervical cancer, 8/76 (11%) for vulval cancer and 7/76 (9%) for endometrial cancer. Patients were usually discharged after 5 years (82/117 (70%)), whereas three (3%) were discharged after 4 years, nine (8%) after three years and one (1%) after 2 years. CONCLUSIONS: Practice varied but most used a standard hospital-based protocol of appointments for 5 years and routine tests were performed usually for women with ovarian cancer. A minority utilised nurse-led or telephone follow-up. General practitioners were rarely involved in routine care. A randomised study comparing various models of follow-up could be considered.