The utility of physical examination in ovarian cancer recurrence detection: a retrospective analysis informing virtual surveillance care

Abstract

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.

Patient-Initiated Follow-Up in Ovarian Cancer

“…This suggested that routine appointments for physical examination have very little value in the early detection of ovarian cancer recurrences. Our findings are consistent with other studies that reported a limited role of regular physical examination for detection of ovarian cancer recurrence, as most were detected by tumour markers or symptoms [ 12 , 13 , 24 ]. Indeed this finding was consistent with published data suggesting that for many cancers, recurrences are not commonly detected in asymptomatic patients at FU consultations and most recurrences are reported as interval events [ 25 ].…”

“…Ovarian cancer, unlike endometrial cancer, has a higher risk of recurrence but there is commonly a tumour marker (CA125) that is clinically useful for disease monitoring. A combination of PIFU with routine CA125 measurement may be an option that could reduce the number of hospital appointments while maintaining or improving patient reassurance, as most ovarian cancer recurrence is detected by tumour markers or symptoms [ 12 , 13 ].…”

Patient perspectives of telemedicine in gynecologic oncology during COVID

“…In this study, it was speculated that the apprehension was due to the perception that a physical exam was critical for detecting recurrence. Recent research has called into question whether a physical examination is required with every visit during cancer surveillance ( Janke et al, 2022 ). Additionally, prior studies have demonstrated that apprehension regarding lack of a hands-on physical exam can be overcome by explaining to patients why a physical exam is not always necessary ( Sabesan, 2014 ).…”