TY - JOUR
T1 - Variation in gynecological oncology follow-up practice
T2 - Attributable to cancer centers or to patient characteristics? A Piedmont Regional Oncology Network Study
AU - Fuso, Luca
AU - Evangelista, Andrea
AU - Pagano, Eva
AU - Piovano, Elisa
AU - Perotto, Stefania
AU - Mazzola, Simona
AU - Bertoldo, Emiliana
AU - La Porta, Maria Rosa
AU - Rosmino, Claudia
AU - Furbatto, Graziella
AU - Abate, Sergio
AU - Di Costanzo, Gianna
AU - Trossarelli, Gianfranco
AU - Baù, Maria Grazia
AU - Carnino, Flavio
AU - Gambaro, Giuseppina
AU - Piantanida, Paola
AU - Alabiso, Oscar
AU - Galletto, Luciano
AU - Zavallone, Laura
AU - Rossi, Annalisa
AU - Barbero, Maggiorino
AU - Tessa, Maria
AU - Katsaros, Dionyssios
AU - Danese, Saverio
AU - Brignolo, Paola
AU - Gorzegno, Gabriella
AU - Grillo, Raffaella
AU - Apolone, Giovanni
AU - Ciccone, Giovannino
AU - Zola, Paolo
PY - 2011
Y1 - 2011
N2 - 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.
AB - 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.
KW - Appropriateness
KW - Evidence- based medicine
KW - Follow-up
KW - Gynecological cancer
UR - http://www.scopus.com/inward/record.url?scp=83055193691&partnerID=8YFLogxK
U2 - 10.1177/030089161109700502
DO - 10.1177/030089161109700502
M3 - Article
SN - 0300-8916
VL - 97
SP - 551
EP - 558
JO - Tumori
JF - Tumori
IS - 5
ER -