DO NOT USE EXTENSIVE TESTING IN OVARIAN CANCER FOLLOW UP

NEW YORK (Reuters Health) - Despite evidence that cancer antigen 125 (CA-125) tests and CT scans for surveillance in ovarian cancer patients are not beneficial after treatment, the practice continues, according to a multicenter study.

As Dr. Katharine M. Esselen told Reuters Health by email, "We found that patients with ovarian cancer are routinely undergoing blood tests and CT scans to look for recurrent disease after completing treatment for their cancer, despite the fact that a large clinical trial suggested that this may not help women live longer or improve their quality of life, and there are high costs associated."

The trial in question was conducted in 2009 and national guidelines characterize CA-125 testing as optional and discourage the use of radiographic imaging for routine surveillance.

To examine clinical practice, Dr. Esselen of Harvard Medical School in Boston and colleagues prospectively followed women with ovarian cancer in clinical remission after completion of primary cytoreductive surgery and chemotherapy. The finding appeared online July 21 in JAMA Oncology.

In all, 1,241 women were treated at National Cancer Institute-designated cancer centers between 2004 and 2011 and followed until the end of 2012.

During 12 months of surveillance, the cumulative incidence of patients undergoing three or more CA-125 tests was 86% in 2004 to 2009. From 2010 to 2012 this rose to 91%. The cumulative incidence of patients undergoing more than one CT scan was 81% in the earlier period and 78% in the later period.

In the 511 women whose CA-125 markers doubled, there was no significant difference in the time to retreatment with chemotherapy before and after 2009. During a 12-month period, a mean of 4.6 CA-125 tests and 1.7 CT scans were performed per patient.

The researchers conclude that, "the recommendation to avoid routine surveillance testing has not been adopted into clinical practice" and "CT scans appear to be routinely used, at significant cost. These practices have significant, but poorly understood, psychosocial and cost implications, and no benefit on survival to date."

For example," Dr. Esselen pointed out, "if women around the country are getting similar testing, it may cost more than $16 million annually and it's not clear that this is high-value care."

Dr. James S. Goodwin, author of an accompanying editorial, told Reuters Health by email, "It is very difficult for physicians to resist the temptation to order more tests. They think: 'How can more information hurt?'"

"The Esselen study is an excellent example of how it can," said Dr. Goodwin of the University of Texas Medical Branch, Galveston.

However, "While physicians may be challenged dealing with uncertainty, many of our patients refuse absolutely to tolerate it," he adds in his editorial.

But, he points out, "We do not discuss heart transplants with patients who have mild congestive heart failure. Why would we discuss CA-125 testing with women who have ovarian cancer in remission?"

SOURCE: http://bit.ly/2anQFRQ and http://bit.ly/2aC88mA

JAMA Oncol 2016.