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ObjectivesGiven the recent rapid increase in telemedicine in the setting of the COVID-19 pandemic, we sought to investigate the utility of symptom review, CA125, and physical examination in the detection of ovarian cancer recurrence to determine the role of virtual surveillance care in the COVID-19 era.MethodsThis retrospective cohort study included patients diagnosed with ovarian cancer between 2013 and 2020 who achieved remission after primary treatment and then had recurrence while in a routine surveillance program. Modalities that detected recurrence including symptoms, CA125, physical examination, or ‘other,’ which was denoted if imaging was obtained for reasons other than suspected recurrence and recurrence was incidentally identified, were recorded. Descriptive statistics were performed to summarize the cohort.ResultsOne hundred and nine patients met inclusion criteria. At time of recurrence, elevated CA125 was present in 97 (89.0%) patients, symptoms in 41 (37.6%), and abnormal physical exam findings in 27 (24.8%). Recurrence was incidentally found with imaging obtained for reasons other than suspicion of recurrence in six (5.5%) patients. Recurrence was suspected based on multiple modalities in 46 (42.2%) patients. Elevated CA125, symptoms, or both were present in 102 (93.6%) patients. Of patients with abnormal physical exam findings, 26 (96.3%) also had elevated CA125 or symptoms present. Recurrence was suspected based on physical exam findings alone in one (0.9%) patient.ConclusionsOver 90% of ovarian cancer recurrences were detected by rising CA125, symptoms, or both. Only one patient had recurrence detected by physical examination alone. Given that review of symptoms and CA125 can be conducted virtually, virtual visits may offer a reasonable alternative to in-person visits for ovarian cancer surveillance for patients who have pre-treatment elevated CA125.

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Disease recurrence is commonly seen in ovarian cancer despite optimal treatment, with approximately 80% of those with advanced-stage disease experiencing recurrence. Because of this concerning recurrence rate, surveillance, including screening for symptoms, physical examination, serum CA-125 level, and imaging are commonly used by gynecologic oncologists. In the middle of the COVID-19 pandemic, routine in-person visits with routine pelvic examinations were limited, sparking questions around the efficacy of the pelvic examination in detection of ovarian cancer recurrence. The optimal virtual surveillance strategy for recurrent ovarian cancer remains unclear.This retrospective cohort study aimed to investigate the utility of symptom review, CA-125 measurement, and physical examination in the detection of ovarian cancer recurrence to determine the role of virtual surveillance role in the COVID-19 era. Patients diagnosed with primary ovarian, fallopian tube, or peritoneal cancer between January 2013 and December 2018 at a single academic medical center were included if they completed standard-of-care treatment with surgical resection and platinum doublet chemotherapy and had no evidence of disease after completion of treatment and then subsequently experienced disease recurrence. Patients were excluded if they did not have a pretreatment elevated serum CA-125 (>35 U/mL). Recurrence detection was defined with one of the following discrete categorical variables: concerning symptoms reported by the patient, clinically relevant rise in CA-125 (rise to greater than or equal to twice the nadir level), abnormal physical examination findings, or other.A total of 272 patients were identified, of whom 109 had recurrence and were included in the final study cohort. The majority of patients had advanced-stage disease, with 73 (67%) having stage III disease and 26 (23.9%) having stage IV disease. The median overall survival was 56 months (95% confidence interval, 46-79 months). At the time of recurrence, elevated CA-125 was seen in 97 patients (89%) and abnormal physical examination findings in 27 patients (24.8%). Recurrence was suspected based on multiple modalities in 46 patients (42.2%), with the most common combination being elevated ) and the second most common being elevated CA-125, concerning symptoms, and abnormal physical examination (16 [14.7%]). Elevated CA-125, symptoms, or both were present in 102 patients (93.6%) who experienced recurrence. Of the 27 patients with abnormal physical examination findings and recurrence, 22 (81.5%) had multifocal disease, and 5 (18.5%) had isolated disease. A single patient had recurrence suspected based on abnormal physical examination findings alone.This retrospective cohort study examining patients with ovarian cancer and elevated baseline CA-125 who achieved remission followed by disease recurrence found that the majority of patients had recurrence detected by elevated CA-125, symptoms or a combination of the two. These findings suggest that the physical examination may be of limi...

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