Variation in gynecological oncology follow-up practice: attributable to cancer centers or to patient characteristics? A Piedmont Regional Oncology Network Study

AIMS AND BACKGROUNDAlthough guidelines recommend minimalist follow-up, there is wide variability in gynecological oncology practice. The aims of this study were to describe between-center differences in the follow-up of endometrial, ovarian, and uterine cervical cancer; to identify the determinants...

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Published in:Tumori 2011-09, Vol.97 (5), p.551-558
Main Authors: Fuso, Luca, Evangelista, Andrea, Pagano, Eva, Piovano, Elisa, Perotto, Stefania, Mazzola, Simona, Bertoldo, Emiliana, La Porta, Maria Rosa, Rosmino, Claudia, Furbatto, Graziella, Abate, Sergio, Di Costanzo, Gianna, Trossarelli, Gianfranco, Baù, Maria Grazia, Carnino, Flavio, Gambaro, Giuseppina, Piantanida, Paola, Alabiso, Oscar, Galletto, Luciano, Zavallone, Laura, Rossi, Annalisa, Barbero, Maggiorino, Tessa, Maria, Katsaros, Dionyssios, Danese, Saverio, Brignolo, Paola, Gorzegno, Gabriella, Grillo, Raffaella, Apolone, Giovanni, Ciccone, Giovannino
Format: Article
Language:English
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Summary:AIMS AND BACKGROUNDAlthough guidelines recommend minimalist follow-up, there is wide variability in gynecological oncology practice. The aims of this study were to describe between-center differences in the follow-up of endometrial, ovarian, and uterine cervical cancer; to identify the determinants of test prescription; to estimate the related costs; and to assess the weight of center habits and patient characteristics as sources of unexplained variability. METHODS AND STUDY DESIGNThe medical records of patients treated between August 2004 and July 2005 for gynecological malignancies and followed up for the detection of recurrent disease were retrospectively collected from 29 centers of the Piedmont Oncology Network. Multivariate multilevel analyses were performed to study the determinants of test prescription and costs. RESULTSAnalyses were performed on 351 patients (median follow-up: 578 days). The unexplained variability in computed tomography prescriptions (26%), ultrasound prescriptions (17%), and total cost of follow-up (15%) can be attributed to center habits, independenty of the clinical characteristics of the patients. CONCLUSIONSMuch of the unexplained variability in the follow-up for gynecological malignancies is attributable to different habits of centers belonging to a cancer network. These results prompted us to design a multicenter randomized controlled trial to compare minimalist versus intensive follow-up programs in endometrial cancer.
ISSN:2038-2529
DOI:10.1700/989.10710