Cervical cancer is the second most common cause of death in women worldwide. The development of new diagnostic, treatment and follow-up strategies for cervical cancer merits attention. After completing treatment for cervical cancer, women are followed-up at regular intervals by their doctor/healthcare professional to identify whether the cancer has come back or has continued to grow even before the woman experiences symptoms of this. Follow-up also helps doctors to monitor for side effects that have happened because of the treatment. Currently, women in the UK usually have follow-up appointments every three months for one year, every six months for the next two years and then yearly for five years after completion of treatment. The idea behind these follow-up appointments is that women will receive prompt treatment if the cancer has come back, and this will improve their survival from the cancer and their quality of life. Evidence from RCTs is needed to ascertain whether this is the case. If it is, we also need to know how often it is best for women to have follow-up appointments, which healthcare professional should conduct the follow-up and what should happen at follow-up appointments, for example, what investigations would be useful.
In this review, we searched for randomised controlled trials that compared different follow-up approaches after first treatment for cervical cancer. We aimed to compare follow-up that is medical or nurse-led and is set down in a written procedure versus follow-up that is medical or nurse-led but responsive to the needs of women rather than being written in a procedure and delivered at pre-set times. We also wished to compare these types of follow-up versus follow-up initiated by the patient.
Although we checked 1,377 titles and abstracts, we found no relevant trials that met the inclusion criteria. Therefore, no evidence is available to suggest that any form of follow-up approach is better or worse in terms of prolonging survival, improving quality of life or guiding the management of problems that can arise because of the treatment and that in the case of radiotherapy treatment worsen with time. This review highlights the need for good quality studies to compare different follow-up approaches after first-line treatment for cervical cancer. This information will be needed in the future to help women and healthcare professionals plan effective follow-up care after treatment for cervical cancer has been completed.
We found no evidence to inform decisions about different follow-up protocols after primary treatment for women with cervical cancer. Ideally, a large RCT or, at the very least, well-designed non-randomised studies (NRSs) that use multi-variate analysis to adjust for baseline imbalances are needed to compare these follow-up protocols. Such studies could include prospective trials conducted to determine the benefits and harms of different follow-up protocols upon completion of primary treatment for cervical cancer, along with an RCT undertaken to compare predefined follow-up protocols versus participant-initiated follow-up versus no follow-up until a participant is referred to a gynaecological oncology service after signs or symptoms of recurrence have been identified in the primary care or community setting.
Cervical cancer is the second most common cancer among women up to 65 years of age and is the most frequent cause of death from gynaecological cancers worldwide. Although surveillance of women after completion of primary treatment for cervical cancer is purported to have an impact on their overall survival (OS), no strictly defined follow-up protocols are available for these women. Wide diversity in management has been noted in the follow-up of women who have completed primary treatment for cervical cancer. Traditionally, women treated for cervical cancer undergo routine long-term, even life-long, follow-up. The primary objective of this practice has been to detect and treat recurrence early. This review sets out to systematically evaluate available evidence for the role of different models of follow-up after cervical cancer and the optimal use of investigations.
To evaluate the benefits, harms and costs of different follow-up protocols for women who have completed primary treatment for cervical cancer.
We searched CENTRAL (The Cochrane Library 2013, Issue 1), the Cochrane Gynaecological Cancer Group (CGCG) Trials Register, MEDLINE and EMBASE up to January 2013. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of clinical guidelines and review articles and contacted experts in the field.
We searched for randomised controlled trials (RCTs) that compared different follow-up protocols after primary treatment in women with cervical cancer.
Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. No trials were found, and therefore no data were analysed.
The search strategy identified 1,377 unique references, of which all were excluded on the basis of title and abstract.