British Gynaecological Cancer Society recommendations and guidance on patient-initiated follow-up (PIFU)

Abstract

The National Cancer Survivorship Initiative through the National Health Service (NHS) improvement in the UK started the implementation of stratified pathways of patient-initiated follow-up (PIFU) across various tumor types. Now the initiative is continued through the Living With and Beyond Cancer program by NHS England. Evidence from non-randomized studies and systematic reviews does not demonstrate a survival advantage to the long-established practice of hospital-based follow-up regimens, traditionally over 5 years. Evidence shows that patient needs are inadequately met under the traditional follow-up programs and there is therefore an urgent need to adapt pathways to the needs of patients. The assumption that hospital-based follow-up is able to detect cancer recurrences early and hence improve patient prognosis has not been validated. A recent survey demonstrates that follow-up practice across the UK varies widely, with telephone follow-up clinics, nurse-led clinics and PIFU becoming increasingly common. There are currently no completed randomized controlled trials in PIFU in gynecological malignancies, although there is a drive towards implementing PIFU. PIFU aims to individualize patient care, based on risk of recurrence and holistic needs, and optimizing resources. The British Gynaecological Cancer Society wishes to provide the gynecological oncology community with guidance and a recommendations statement regarding the value, indications, and limitations of PIFU in endometrial, cervical, ovarian, and vulvar cancers in an effort to standardize practice and improve patient care.

Gynecologic cancer surveillance in the era of SARS-CoV-2 (COVID-19)

“…Before the pandemic, follow-up guidelines and recommendations were published for the management of gynecologic cancer survivors. [17][18][19][20][21][22] The COVID-19 crisis may encourage implementation of less intensive and more cost-effective surveillance, and it may be an opportunity for integrating telemedicine and shared decisionmaking processes into the healthcare system. These changes may permanently transform the follow-up of gynecologic cancer survivors and offer a personalized approach.…”

“…A review of the evidence-based data and established guidelines was performed to identify signs of recurrence and abandon unnecessary or wasteful interventions. [17][18][19][20][21][22][23][24] As a consequence, we propose telemedicine-based, risk-stratified surveillance schemes supported by evidence and a shared decision-making program for gynecologic cancer survivors in the COVID-19 era.…”

COVID-19 and gynecological cancer: a review of the published guidelines

“…31 36 Oncological treatment guidelines Many of the recommendations listed above relating to surgical procedures also apply to oncological treatments. Outpatient follow-up has been changed in many hospitals to telephone and video consultations or patient initiated follow-up 37 ; non-essential follow-up has been stopped, and other procedures such as blood tests are done locally or using a drive-through service. 9 Oral medication is delivered home and hospital visits are minimized.…”

From physical to virtual: How the COVID-19 pandemic changed a tertiary gynaecologic oncology surveillance program in Ireland

“…This is also the case internationally ( Kew and Cruickshank, 2006 ). The aim of this practice is to detect asymptomatic recurrences and, through earlier detection, improve outcome, as well as manage side effects of treatment and provide support ( Newton et al, 2020 ). Evidence demonstrating improved survival for this practice is lacking ( Owen and Duncan, 1996 , Fung-Kee-Fung et al, 2006 ) and evidence also suggests that this regime may not meet cancer survivors needs ( Sperling et al, 2014 ).…”