Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines

BACKGROUND: Women with ovarian cancer can present with a variety of symptoms and signs, and an increasing range of tests are available for their investigation. A number of international guidelines provide advice for the initial assessment of possible ovarian cancer in symptomatic women. We systemati...

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Autores principales: Funston, Garth, Van Melle, Marije, Baun, Marie-Louise Ladegaard, Jensen, Henry, Helsper, Charles, Emery, Jon, Crosbie, Emma J., Thompson, Matthew, Hamilton, Willie, Walter, Fiona M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823968/
https://www.ncbi.nlm.nih.gov/pubmed/31676000
http://dx.doi.org/10.1186/s12885-019-6211-2
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author Funston, Garth
Van Melle, Marije
Baun, Marie-Louise Ladegaard
Jensen, Henry
Helsper, Charles
Emery, Jon
Crosbie, Emma J.
Thompson, Matthew
Hamilton, Willie
Walter, Fiona M.
author_facet Funston, Garth
Van Melle, Marije
Baun, Marie-Louise Ladegaard
Jensen, Henry
Helsper, Charles
Emery, Jon
Crosbie, Emma J.
Thompson, Matthew
Hamilton, Willie
Walter, Fiona M.
author_sort Funston, Garth
collection PubMed
description BACKGROUND: Women with ovarian cancer can present with a variety of symptoms and signs, and an increasing range of tests are available for their investigation. A number of international guidelines provide advice for the initial assessment of possible ovarian cancer in symptomatic women. We systematically identified and reviewed the consistency and quality of these documents. METHODS: MEDLINE, Embase, guideline-specific databases and professional organisation websites were searched in March 2018 for relevant clinical guidelines, consensus statements and clinical pathways, produced by professional or governmental bodies. Two reviewers independently extracted data and appraised documents using the Appraisal for Guidelines and Research Evaluation 2 (AGREEII) tool. RESULTS: Eighteen documents from 11 countries in six languages met selection criteria. Methodological quality varied with two guidance documents achieving an AGREEII score ≥ 50% in all six domains and 10 documents scoring ≥50% for “Rigour of development” (range: 7–96%). All guidance documents provided advice on possible symptoms of ovarian cancer, although the number of symptoms included in documents ranged from four to 14 with only one symptom (bloating/abdominal distension/increased abdominal size) appearing in all documents. Fourteen documents provided advice on physical examinations but varied in both the examinations they recommended and the physical signs they included. Fifteen documents provided recommendations on initial investigations. Transabdominal/transvaginal ultrasound and the serum biomarker CA125 were the most widely advocated initial tests. Five distinct testing strategies were identified based on the number of tests and the order of testing advocated: ‘single test’, ‘dual testing’, ‘sequential testing’, ‘multiple testing options’ and ‘no testing’. CONCLUSIONS: Recommendations on the initial assessment and investigation for ovarian cancer in symptomatic women vary considerably between international guidance documents. This variation could contribute to differences in the way symptomatic women are assessed and investigated between countries. Greater research is needed to evaluate the assessment and testing approaches advocated by different guidelines and their impact on ovarian cancer detection.
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spelling pubmed-68239682019-11-06 Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines Funston, Garth Van Melle, Marije Baun, Marie-Louise Ladegaard Jensen, Henry Helsper, Charles Emery, Jon Crosbie, Emma J. Thompson, Matthew Hamilton, Willie Walter, Fiona M. BMC Cancer Research Article BACKGROUND: Women with ovarian cancer can present with a variety of symptoms and signs, and an increasing range of tests are available for their investigation. A number of international guidelines provide advice for the initial assessment of possible ovarian cancer in symptomatic women. We systematically identified and reviewed the consistency and quality of these documents. METHODS: MEDLINE, Embase, guideline-specific databases and professional organisation websites were searched in March 2018 for relevant clinical guidelines, consensus statements and clinical pathways, produced by professional or governmental bodies. Two reviewers independently extracted data and appraised documents using the Appraisal for Guidelines and Research Evaluation 2 (AGREEII) tool. RESULTS: Eighteen documents from 11 countries in six languages met selection criteria. Methodological quality varied with two guidance documents achieving an AGREEII score ≥ 50% in all six domains and 10 documents scoring ≥50% for “Rigour of development” (range: 7–96%). All guidance documents provided advice on possible symptoms of ovarian cancer, although the number of symptoms included in documents ranged from four to 14 with only one symptom (bloating/abdominal distension/increased abdominal size) appearing in all documents. Fourteen documents provided advice on physical examinations but varied in both the examinations they recommended and the physical signs they included. Fifteen documents provided recommendations on initial investigations. Transabdominal/transvaginal ultrasound and the serum biomarker CA125 were the most widely advocated initial tests. Five distinct testing strategies were identified based on the number of tests and the order of testing advocated: ‘single test’, ‘dual testing’, ‘sequential testing’, ‘multiple testing options’ and ‘no testing’. CONCLUSIONS: Recommendations on the initial assessment and investigation for ovarian cancer in symptomatic women vary considerably between international guidance documents. This variation could contribute to differences in the way symptomatic women are assessed and investigated between countries. Greater research is needed to evaluate the assessment and testing approaches advocated by different guidelines and their impact on ovarian cancer detection. BioMed Central 2019-11-01 /pmc/articles/PMC6823968/ /pubmed/31676000 http://dx.doi.org/10.1186/s12885-019-6211-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Funston, Garth
Van Melle, Marije
Baun, Marie-Louise Ladegaard
Jensen, Henry
Helsper, Charles
Emery, Jon
Crosbie, Emma J.
Thompson, Matthew
Hamilton, Willie
Walter, Fiona M.
Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines
title Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines
title_full Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines
title_fullStr Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines
title_full_unstemmed Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines
title_short Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines
title_sort variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823968/
https://www.ncbi.nlm.nih.gov/pubmed/31676000
http://dx.doi.org/10.1186/s12885-019-6211-2
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