Impact of Routine Follow-Up Examinations on Life Expectancy in Ovarian Cancer Patients: A Simulation Study

2012 ◽  
Vol 22 (7) ◽  
pp. 1150-1157 ◽  
Author(s):  
Sandra M. E. Geurts ◽  
Femmie de Vegt ◽  
Anne M. van Altena ◽  
Vivianne C. G. Tjan-Heijnen ◽  
Leon F. A. G. Massuger ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Life Expectancy ◽  
Cancer Patients ◽  
Transition Probabilities ◽  
Treatment Options ◽  
Recurrent Ovarian Cancer ◽  
Markov Modeling ◽  
Mortality Ratio ◽  
The Impact

ObjectiveThe clinical benefit of routine follow-up in patients treated for ovarian cancer is subject to debate. In this study, the magnitude of the potential survival benefit of routine examinations was evaluated by Markov modeling.MethodsThe clinical course of ovarian cancer was simulated using a 4-state nonstationary Markov model. Risk of recurrence and mortality probabilities were derived from individual patient data and Statistics Netherlands. The life expectancy was simulated for 3 follow-up scenarios: a current, withholding (all recurrences detected symptomatically), and perfect follow-up program (all recurrences detected asymptomatically). The impact of effective recurrence treatment in the future was modeled by varying the mortality ratio between patients with asymptomatically versus symptomatically detected recurrences. The model was validated using empirical data.ResultsThe mean life expectancy of patients, aged 58 years and in complete clinical remission after primary treatment, was 10.8 years. Varying the transition probabilities with ±25% changed the life expectancy by up to 1.1 years. The modeled life expectancy for the withholding and perfect follow-up scenarios was also 10.8 years and insensitive to model assumptions. In patients with stages IIB to IV, the life expectancy was 7.0 years, irrespective of follow-up strategy. A mortality ratio of 0.8 for patients with asymptomatically versus symptomatically detected recurrences resulted in a gain in life expectancy of 5 months for withholding versus perfect follow-up.ConclusionsRoutine follow-up in ovarian cancer patients is not expected to improve the life expectancy. The timing of detection of recurrent ovarian cancer is immaterial until markedly improved treatment options become available.

Expression III: What do primary and recurrent ovarian cancer (OC) patients expect from their doctors and therapy management? Results of a survey in eight European countries with 1,743 patients (NOGGO/ENGOT-OV9 study).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5569-5569 ◽  
Author(s):  
Gülten Oskay-Özcelik ◽  
Maren Keller ◽  
Sandro Pignata ◽  
Domenica Lorusso ◽  
Florence Joly ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Information Needs ◽  
Treatment Options ◽  
Recurrent Ovarian Cancer ◽  
European Countries ◽  
Second Opinion ◽  
Cancer Therapies ◽  
Therapy Management

5569 Background: The primary aim of this study was to investigate information needs and preferences among patients with ovarian cancer, focusing especially on doctor-patient relationships and therapy management in different European countries. Methods: A questionnaire was developed based on the experiences of expression II, a German survey, and then provided to primary and recurrent ovarian cancer patients via internet (online) or as a print-version in 8 countries in Europe (Austria, Belgium, France, Germany, Italy, Poland, Rumania, Spain). In the first part basic data (age, tumour status, therapy) were requested from the patient. In the second part, most of the questions tried to evaluate the expectations and needs concerning their therapy management and doctor-patient communication. Results: From December 2009 to October 2012, a total of 1743 patients with ovarian cancer from 8 European countries participated in the survey.The median age was 58 years (range 16-89). Nearly all patients (96,3%) had a primary surgery and a first-line chemotherapy (91,5%). About 423 (25,7%) patients were included in another clinical trial.Most of the patients in each country were pleased with the completeness and understandability of the explanations about the therapies from their doctors. About 68% of patients would be interested in having the opportunity to have a second opinion. The three most important aspects, which were proposed by patients to improve therapy against ovarian cancer were: “the therapy should not induce alopecia” (42%), “there must be more done to counter fatigue” (34%), and “the therapy should be more effective” (29%). Conclusions: This study underlines the high need of ovarian cancer patients to discuss all details concerning treatment options and clinical management with only minor difference between the countries. Patients also need more information about side effects of cancer therapies and second opinion opportunities. Besides effectiveness of therapy, alopecia and fatigue are the most important side effects bothering the patients.

Evaluation of BRCA1/2 and homologous recombination defects in ovarian cancer and impact on clinical outcomes.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5511-5511 ◽  
Author(s):  
Melinda S. Yates ◽  
Kirsten Timms ◽  
Molly S Daniels ◽  
Holly D. Oakley ◽  
Mark F. Munsell ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Homologous Recombination ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Germline Mutation ◽  
Large Scale ◽  
Recurrent Ovarian Cancer ◽  
State Transitions ◽  
Cancer Genes ◽  
The Impact

5511 Background: Recent studies show that germline or somatic BRCA1/2 mutations and homologous recombination (HR) defects can be used to predict response to PARP inhibitors in recurrent ovarian cancer. However, the impact of defects in BRCA1/2 and HR genes on overall clinical outcomes are not yet defined for patients undergoing neoadjuvant chemotherapy (NACT) versus upfront surgical debulking (USD). Methods: Previously untreated ovarian cancer patients were prospectively enrolled under approved IRB protocol. Germline and tumor BRCA1/2 mutation testing and methylation were analyzed when sufficient tumor and blood was available. Mutation in 21 additional hereditary cancer genes (including HR genes) was also evaluated. Tumor HR defects were scored on LOH, telomeric allelic imbalance, and large-scale state transitions (as previously described). Presence of germline or somatic BRCA1/2 mutations, BRCA1 methylation, HR score ≥42, or germline mutation in other HR genes were defined together as HRD positive. Results: Of 299 enrolled patients, 129 (43%) received USD and 170 (57%) received NACT. Patients receiving USD had better outcomes compared to NACT, including overall survival (OS, 65.8 vs 45.2 months, p = 0.0003) and event free survival (EFS, 24.8 vs 15.6 months, p < 0.0001). In the overall cohort, EFS was significantly longer for HRD positive patients vs HRD negative (20.5 vs 16.3 months, p = 0.0268). Patients with somatic and germline BRCA1/2 mutations had longer OS vs BRCA1/2 negative (65.3 vs 46.1 months, p = 0.0403). Overall outcomes were worse in NACT compared to USD, but impact of BRCA1/2 mutations and HR defects was stronger in this group. NACT patients with any HR defect had longer EFS (19.7 vs 14.5 months, p = 0.0247). NACT patients with BRCA1/2 germline mutations had longer OS (65.3 vs 38.3 months, p = 0.0230). NACT patients with BRCA1/2 germline mutation had longer EFS (22.6 vs 14.6 months, p = 0.0047). OS and EFS in USD patients were significantly changed based on only debulking status; mutation or HR status did not have a statistically significant effect. Conclusions: While HR defects and BRCA1/2 mutations influence overall outcomes for ovarian cancer patients, the impact is stronger in NACT compared to USD.

No Supportive Evidence for Clinical Benefit of Routine Follow-Up in Ovarian Cancer: A Dutch Multicenter Study

2011 ◽  
Vol 21 (4) ◽  
pp. 647-653 ◽  
Author(s):  
Sandra M.E. Geurts ◽  
Anne M. van Altena ◽  
Femmie de Vegt ◽  
Vivianne C.G. Tjan-Heijnen ◽  
Leon F.A.G. Massuger ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Tumor Biology ◽  
Recurrent Ovarian Cancer ◽  
Primary Treatment ◽  
Survival Times ◽  
National Guidelines ◽  
Fallopian Tube Cancer ◽  
Curative Intent

Introduction:Routine follow-up is standard medical practice in ovarian cancer patients treated with curative intent. However, no strong evidence exists indicating that prognosis is improved. The objective of this study was to evaluate the routine follow-up schedule for ovarian cancer patients regarding the adherence to the Dutch protocol, the detection of recurrences, and the follow-up's impact on overall survival.Methods:All 579 consecutive patients diagnosed with epithelial ovarian, primary peritoneal, or fallopian tube cancer in 4 Dutch hospitals between 1996 and 2006 were selected. Only patients in complete clinical remission after primary treatment were studied. Compliance to the Dutch follow-up guideline was assessed in a random sample of 68 patients. Of the 127 patients with recurrence, the mode of recurrence detection was addressed. Survival time since primary treatment was calculated using the Kaplan-Meier method.Results:The patients received more follow-up visits than was recommended according to the guideline. The cumulative 5-year risk of recurrence was 55% (95% confidence interval [CI], 43%-67%). The survival of patients with recurrent ovarian cancer detected asymptomatically at a routine visit (n = 51) tended to be better compared with patients with symptomatic detection at a routine (n = 31) or diagnosed after an interval visit (n = 31). The median survival times were 44 (95% CI, 38-64), 29 (95% CI, 21-38), and 33 months (95% CI, 19-61), respectively (P= 0.08). The median time from primary treatment to recurrence was similar for the 3 groups: 14, 10, and 11 months, respectively (P= 0.26).Conclusions:Follow-up in line with (inter)national guidelines yields a seemingly longer life expectancy if the recurrence was detected asymptomatically. However, this result is expected to be explained by differences in tumor biology and length-time bias.

scholarly journals Long-Term Follow-Up of Gemogenovatucel-T (Vigil) Survival and Molecular Signals of Immune Response in Recurrent Ovarian Cancer

Vaccines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 894
Author(s):  
Rodney P. Rocconi ◽  
Laura Stanbery ◽  
Luciana Madeira da Silva ◽  
Robert A. Barrington ◽  
Phylicia Aaron ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Recurrent Ovarian Cancer ◽  
Elispot Response ◽  
Mhc Ii ◽  
Long Term Follow Up ◽  
Molecular Signals ◽  
The Relationship

Aim: To determine the relationship between gene expression profile (GEP) and overall survival (OS) by NanoString following treatment with Vigil. Patients and Methods: Recurrent ovarian cancer patients (n = 21) enrolled in prior clinical trials. Results: GEP stratified by TISHIGH vs. TISLOW demonstrated OS benefit (NR vs. 5.8 months HR 0.23; p = 0.0379), and in particular, MHC-II elevated baseline expression was correlated with OS advantage (p = 0.038). Moreover, 1-year OS was 75% in TISHIGH patients vs. 25% in TISLOW (p = 0.03795). OS was also correlated with positive γ-IFN ELISPOT response, 36.8 vs. 23.0 months (HR 0.19, p = 0.0098). Conclusion: Vigil demonstrates OS benefit in correlation with TISHIGH score, elevated MHC-II expression and positive γ-IFN ELISPOT in recurrent ovarian cancer patients.

scholarly journals Could different treatment approaches in acromegaly influence life expectancy? A comparative study between Bulgaria and Campania (Italy)

2014 ◽  
Vol 171 (2) ◽  
pp. 263-273 ◽  
Author(s):  
Annamaria Colao ◽  
Silvia Vandeva ◽  
Rosario Pivonello ◽  
Ludovica Francesca Stella Grasso ◽  
Emil Nachev ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Disease Control ◽  
Treatment Options ◽  
Somatostatin Analogs ◽  
Survival Rates ◽  
Treatment Modalities ◽  
Standardized Mortality Ratio ◽  
Biochemical Control ◽  
Mortality Ratio ◽  
The Impact

BackgroundMortality in acromegaly strictly depends on optimal control of GH and IGF1 levels. Modern medical therapy with somatostatin analogs (SSAs) and GH receptor antagonists (GHRAs) is not available in many countries due to funding restrictions. This retrospective, comparative, cohort study investigated the impact of different treatment modalities on disease control (GH and IGF1) and mortality in acromegaly patients.MethodsTwo cohorts of patients with acromegaly from Bulgaria (n=407) and Campania, Italy (n=220), were compared, and mortality rates were evaluated during a 10-year period (1999–2008).ResultsThe major difference in treatment approach between cohorts was the higher utilization of SSAs and GHRAs in Italy, leading to a decreased requirement for radiotherapy. Significantly more Italian than Bulgarian patients had achieved disease control (50.1 vs 39.1%, P=0.005) at the last follow-up. Compared with the general population, the Bulgarian cohort had a decreased life expectancy with a standardized mortality ratio (SMR) of 2.0 (95% CI 1.54–2.47) that was restored to normal in patients with disease control – SMR 1.25 (95% CI 0.68–1.81). Irradiated patients had a higher cerebrovascular mortality – SMR 7.15 (95% CI 2.92–11.37). Internal analysis revealed an independent role of age at diagnosis and last GH value on all-cause mortality and radiotherapy on cerebrovascular mortality. Normal survival rates were observed in the Italian cohort: SMR 0.66 (95% CI 0.27–1.36).ConclusionsSuboptimal biochemical control was associated with a higher mortality in the Bulgarian cohort. Modern treatment options that induce a strict biochemical control and reduce the necessity of radiotherapy might influence the life expectancy. Other factors, possibly management of comorbidities, could contribute to survival rates.

What do 676 primary and recurrent ovarian cancer (OC) patients expect from their doctors and therapy management? Results of a German survey of the northeastern German Society of Gynecological Oncology (NOGGO).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5044-5044
Author(s):  
Gülten Oskay-Özcelik ◽  
Radoslav Chekerov ◽  
Sylvia Neubert ◽  
Karsten Münstedt ◽  
Hans-Joachim Hindenburg ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Information Needs ◽  
Treatment Options ◽  
Recurrent Ovarian Cancer ◽  
German Society ◽  
Print Version ◽  
Therapy Management ◽  
Primary Surgery ◽  
Patient Relationships

5044 Background: The primary aim of this study was to investigate information needs and preferences among patients with ovarian cancer, focusing especially on doctor-patient relationships and therapy management. Methods: A 42-item questionnaire was developed and validated in a mono-centre phase I study and was then provided to primary and recurrent ovarian cancer patients via internet (online) or as a print-version. In the first part basic data (age, tumour status, therapy) were requested. In the second part, most of the questions try to evaluate the expectations and needs concerning their therapy management and doctor-patients communication. Results: From January to November 2009, a total of 676 (201 online; 475 print version) patients with ovarian cancer from 44 German centres took part in the survey.The median age of the online group was 49 years (range 19-84), for the print group 62 years (26-92). Nearly all patients (98.7%) had a primary surgery and a primary chemotherapy (89%). Asked for side effects during therapy, the most frequent answers were alopecia, paraesthesia/dysaesthesia and fatigue. Most of the patients were content with the completeness and understandability of the explanations about the therapies from their doctors . The three most important aspects, which were proposed by patients to improve therapy against ovarian cancer were: “Doctors should have more time for explanations”, “The therapy should not lead to any loss of hair”, and “The therapy should be more effective”. Conclusions: This study underlines the high need of ovarian cancer patients to discuss all details concerning treatment options and clinical management. As matter of fact, the physician involved in the treatment is the most important source of information.

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