Variation in gynecological oncology follow-up practice: Attributable to cancer centers or to patient characteristics? A Piedmont Regional Oncology Network Study

Author:

Fuso Luca1,Evangelista Andrea2,Pagano Eva2,Piovano Elisa1,Perotto Stefania1,Mazzola Simona1,Bertoldo Emiliana3,La Porta Maria Rosa4,Rosmino Claudia5,Furbatto Graziella6,Abate Sergio7,Di Costanzo Gianna8,Trossarelli Gianfranco9,Baù Maria Grazia10,Carnino Flavio11,Gambaro Giuseppina12,Piantanida Paola13,Alabiso Oscar14,Galletto Luciano15,Zavallone Laura16,Rossi Annalisa17,Barbero Maggiorino18,Tessa Maria19,Katsaros Dionyssios20,Danese Saverio10,Brignolo Paola21,Gorzegno Gabriella22,Grillo Raffaella23,Apolone Giovanni24,Ciccone Giovannino2,Zola Paolo1

Affiliation:

1. Gynecology and Obstetrics Academic Department, Azienda Ospedaliera Ordine Mauriziano, Turin

2. Unit of Cancer Epidemiology, Azienda Ospedaliera US Giovanni Battista, CPO Piemonte, CeRMS, Turin

3. Medical Oncology, Ospedale Civico di Chivasso, Chivasso

4. Radiotherapy, Ospedale di Ivrea, Ivrea

5. Radiotherapy, Ospedale San Giovanni Antica Sede, Turin

6. Gynecology and Obstetrics, Ospedale di Vercelli, Vercelli

7. Gynecology and Obstetrics, Azienda Ospedaliera Santa Croce e Carle, Cuneo

8. Medical Oncology, Azienda Ospedaliera Santa Croce e Carle, Cuneo

9. Gynecology and Obstetrics Academic Department, San Luigi Gonzaga, Orbassano

10. Gynecology and Obstetrics, Azienda Ospedaliera OIRM-Sant'Anna, Turin

11. Gynecology and Obstetrics, Ospedale Martini, Turin

12. Radiotherapy, Ospedale Maggiore della Carità, Novara

13. Gynecology and Obstetrics, Ospedale Maggiore della Carità, Novara

14. Medical Oncology, Ospedale Maggiore della Carità, Novara

15. Gynecology and Obstetrics, Ospedale Civile Edoardo Agnelli, Pinerolo

16. Medical Oncology, Ospedale degli Infermi, Biella

17. Radiotherapy, Azienda Ospedaliera Ordine Mauriziano, Turin

18. Gynecology and Obstetrics, Ospedale Cardinal Massaia, Asti

19. Radiotherapy, Ospedale Cardinal Massaia, Asti

20. Gynecology and Obstetrics Academic Department, Azienda Ospedaliera OIRM-Sant'Anna, Turin

21. Medical Oncology, Ospedale Gradenigo, Turin

22. Medical Oncology, San Luigi Gonzaga, Orbassano

23. Medical Oncology, Centro Oncologico ed Ematologico Subalpino, Azienda Ospedaliera San Giovanni Battista, Turin

24. Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

Abstract

Aims and background Although guidelines recommend minimalist follow-up, there is wide variability in gynecological oncology practice. The aims of this study were to describe between-center differences in the follow-up of endometrial, ovarian, and uterine cervical cancer; to identify the determinants of test prescription; to estimate the related costs; and to assess the weight of center habits and patient characteristics as sources of unexplained variability. Methods and study design The medical records of patients treated between August 2004 and July 2005 for gynecological malignancies and followed up for the detection of recurrent disease were retrospectively collected from 29 centers of the Piedmont Oncology Network. Multivariate multilevel analyses were performed to study the determinants of test prescription and costs. Results Analyses were performed on 351 patients (median follow-up: 578 days). The unexplained variability in computed tomography prescriptions (26%), ultrasound prescriptions (17%), and total cost of follow-up (15%) can be attributed to center habits, independenty of the clinical characteristics of the patients. Conclusions Much of the unexplained variability in the follow-up for gynecological malignancies is attributable to different habits of centers belonging to a cancer network. These results prompted us to design a multicenter randomized controlled trial to compare minimalist versus intensive follow-up programs in endometrial cancer.

Publisher

SAGE Publications

Subject

Cancer Research,Oncology,General Medicine

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