OverviewInnovative Follow-up Strategies for Endometrial Cancer
Section snippets
Statement of Search Strategies Used and Sources of Information
We conducted purposeful searches in Ovid Medline/PubMed using terms related to ‘endometrial cancer’ and ‘follow-up’, between 9 October 2020 and 31 December 2020. Reference lists and citations of relevant articles were used to source other papers and additional online sources (Cancer Research UK) were also used. Articles in English were included.
Patient-initiated Follow-up
The National Cancer Survivorship Initiative through NHS Improvement has recommended implementation of PIFU in many tumour types. The rising incidence of endometrial cancer alongside the excellent prognosis of low-risk disease (Table 1 [4]) has increased interest in such strategies. PIFU programmes aim to empower patients to take ownership of their healthcare following patient education regarding symptoms of recurrence and provides a fast track service into specialised services for those
Follow-up Strategies for Intermediate- and High–intermediate-risk Endometrial Cancer
Intermediate-risk endometrial cancer can be split into intermediate- or high–intermediate-risk disease (Table 1) [4]. In the 2019 study, only 68% of centres in the UK with established PIFU schemes offered PIFU to intermediate-risk patients [23]. Recurrences in intermediate-risk endometrial cancer typically occur within the first 3 years of diagnosis. However, trends towards a secondary peak 7 years after diagnosis have been reported [6], suggesting patients should maintain symptom vigilance
Follow-up Strategies for High-risk Endometrial Cancer
The BGCS currently recommends that all women with high-risk endometrial cancer are offered TFU or HFU for 5 years, although PIFU can be considered after 2 years if acceptable to the patient and treating clinician [18]. High-risk subgroups typically recur in the first 3–4 years after completing primary treatment, with over 70% of recurrences identified in this time [6,8]. Therefore, evidence for continuing intensive HFU beyond year 3/4 in these patient groups is lacking. In addition, most
Cancer Survivorship in Endometrial Cancer
Most women diagnosed with endometrial cancer can expect to survive their disease. Therefore, a core component of follow-up care includes providing comprehensive cancer survivorship care. Cancer survivors and their families have specific needs, which include management of the long-term or late effects of cancer treatment, psychological morbidity alongside health promotion and disease prevention strategies [36]. Gynaecological cancer survivors often have particular unmet needs related to
Future Directions in Endometrial Cancer Follow-up
The traditional follow-up model relying on clinical examination with only symptom-led imaging is presumably based on the paradigm that vaginal recurrence can be cured, whereas systemic treatments for distant disease are significantly less efficacious. However, there are heterogeneous patterns of recurrence with new salvage treatments that can potentially impact on overall survival [51].
In light of recent developments in treatment options for recurrent endometrial cancer, with radiotherapy,
Conclusions
Implementation of alternative follow-up strategies that empower patients to take ownership of their healthcare and improve the patient experience is desirable and as these are now supported by BGCS recommendations, wider uptake and confidence in such schemes is expected. Further research into patient acceptability and the oncological outcomes of PIFU in those with higher-risk disease in a prospective randomised controlled trial is still needed. The COVID-19 pandemic has resulted in a
Conflict of Interest
ELM has served on advisory boards for Inivata and GlaxoSmithKline; received speaker fees from GlaxoSmithKline; has received research grants from Intuitive Surgical and Hope Against Cancer for unrelated work.
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