Endometrial cancer surveillance adherence reduces utilization and subsequent costs

In June 2011, the SGO recommended that physical exam and symptoms be the primary surveillance methods in patients with endometrial cancer. We sought to evaluate adherence to these guidelines by comparing the use of CT scans, paps and serum CA125 ordered for endometrial cancer surveillance before and...

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Veröffentlicht in:	Gynecologic oncology Jg. 146; H. 3; S. 514 - 518
Hauptverfasser:	Schwartz, Zachary P., Frey, Melissa K., Philips, Sarah, Curtin, John P.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Elsevier Inc 01.09.2017
Schlagworte:	Adherence Adult Aged CA-125 Antigen - blood Cost Cytology Endometrial cancer Endometrial Neoplasms - diagnosis Female Guideline Adherence Health Care Costs Humans Middle Aged Outcomes Papanicolaou Test - economics Papanicolaou Test - utilization Physical Examination Practice Guidelines as Topic Retrospective Studies Surveillance Symptom Assessment Tomography, X-Ray Computed - economics Tomography, X-Ray Computed - utilization Watchful Waiting - economics Watchful Waiting - methods Watchful Waiting - standards Adherence Endometrial cancer Surveillance Cost Outcomes Cytology
ISSN:	0090-8258, 1095-6859, 1095-6859
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Abstract	In June 2011, the SGO recommended that physical exam and symptoms be the primary surveillance methods in patients with endometrial cancer. We sought to evaluate adherence to these guidelines by comparing the use of CT scans, paps and serum CA125 ordered for endometrial cancer surveillance before and after publication of these guidelines. A retrospective review was performed for all patients undergoing surveillance for endometrial cancer at a single institution between June 2009 and June 2013. We assessed the number of patients without symptoms or abnormal physical exam findings who underwent surveillance CT scans, paps and/or CA125 during the 2years pre- and 2years post-SGO guidelines. 92 patients (n=48 pre-6/2011, n=44 post-6/2011) were identified. Mean patient age was 58years. No significant difference in age, ethnicity, body mass index, or disease grade or stage was noted. There was a significant decline in surveillance CT scans (n=13, 27% vs. n=4, 9%, p=0.03), CA125 (n=14, 29% vs. 5, 11%, p=0.035) and paps (n=34, 71% vs. n=8 vs. 18%, p<0.001). There was no significant difference in disease status at the last follow-up. Institutional cost of surveillance also declined ($14,102.46 2years pre-guidelines, $3,054.99 2years post-guidelines). In a single urban academic public hospital, after only 2years, clinical adherence to the 2011 SGO endometrial cancer surveillance guidelines resulted in a significant decline in the use of CT scans, CA125 and paps. This reduction does not appear to affect patient outcomes and led to an appreciable decrease in surveillance costs. •Single institution shows decline in CT's, CA125's, and Paps due to SGO guidelines.•Adherence to SGO guidelines did not negatively impact patient outcomes.•Cost of surveillance care declined secondary to adherence to these SGO guidelines.
AbstractList	In June 2011, the SGO recommended that physical exam and symptoms be the primary surveillance methods in patients with endometrial cancer. We sought to evaluate adherence to these guidelines by comparing the use of CT scans, paps and serum CA125 ordered for endometrial cancer surveillance before and after publication of these guidelines. A retrospective review was performed for all patients undergoing surveillance for endometrial cancer at a single institution between June 2009 and June 2013. We assessed the number of patients without symptoms or abnormal physical exam findings who underwent surveillance CT scans, paps and/or CA125 during the 2years pre- and 2years post-SGO guidelines. 92 patients (n=48 pre-6/2011, n=44 post-6/2011) were identified. Mean patient age was 58years. No significant difference in age, ethnicity, body mass index, or disease grade or stage was noted. There was a significant decline in surveillance CT scans (n=13, 27% vs. n=4, 9%, p=0.03), CA125 (n=14, 29% vs. 5, 11%, p=0.035) and paps (n=34, 71% vs. n=8 vs. 18%, p<0.001). There was no significant difference in disease status at the last follow-up. Institutional cost of surveillance also declined ($14,102.46 2years pre-guidelines, $3,054.99 2years post-guidelines). In a single urban academic public hospital, after only 2years, clinical adherence to the 2011 SGO endometrial cancer surveillance guidelines resulted in a significant decline in the use of CT scans, CA125 and paps. This reduction does not appear to affect patient outcomes and led to an appreciable decrease in surveillance costs. In June 2011, the SGO recommended that physical exam and symptoms be the primary surveillance methods in patients with endometrial cancer. We sought to evaluate adherence to these guidelines by comparing the use of CT scans, paps and serum CA125 ordered for endometrial cancer surveillance before and after publication of these guidelines. A retrospective review was performed for all patients undergoing surveillance for endometrial cancer at a single institution between June 2009 and June 2013. We assessed the number of patients without symptoms or abnormal physical exam findings who underwent surveillance CT scans, paps and/or CA125 during the 2years pre- and 2years post-SGO guidelines. 92 patients (n=48 pre-6/2011, n=44 post-6/2011) were identified. Mean patient age was 58years. No significant difference in age, ethnicity, body mass index, or disease grade or stage was noted. There was a significant decline in surveillance CT scans (n=13, 27% vs. n=4, 9%, p=0.03), CA125 (n=14, 29% vs. 5, 11%, p=0.035) and paps (n=34, 71% vs. n=8 vs. 18%, p<0.001). There was no significant difference in disease status at the last follow-up. Institutional cost of surveillance also declined ($14,102.46 2years pre-guidelines, $3,054.99 2years post-guidelines). In a single urban academic public hospital, after only 2years, clinical adherence to the 2011 SGO endometrial cancer surveillance guidelines resulted in a significant decline in the use of CT scans, CA125 and paps. This reduction does not appear to affect patient outcomes and led to an appreciable decrease in surveillance costs. •Single institution shows decline in CT's, CA125's, and Paps due to SGO guidelines.•Adherence to SGO guidelines did not negatively impact patient outcomes.•Cost of surveillance care declined secondary to adherence to these SGO guidelines. In June 2011, the SGO recommended that physical exam and symptoms be the primary surveillance methods in patients with endometrial cancer. We sought to evaluate adherence to these guidelines by comparing the use of CT scans, paps and serum CA125 ordered for endometrial cancer surveillance before and after publication of these guidelines.OBJECTIVESIn June 2011, the SGO recommended that physical exam and symptoms be the primary surveillance methods in patients with endometrial cancer. We sought to evaluate adherence to these guidelines by comparing the use of CT scans, paps and serum CA125 ordered for endometrial cancer surveillance before and after publication of these guidelines.A retrospective review was performed for all patients undergoing surveillance for endometrial cancer at a single institution between June 2009 and June 2013. We assessed the number of patients without symptoms or abnormal physical exam findings who underwent surveillance CT scans, paps and/or CA125 during the 2years pre- and 2years post-SGO guidelines.METHODSA retrospective review was performed for all patients undergoing surveillance for endometrial cancer at a single institution between June 2009 and June 2013. We assessed the number of patients without symptoms or abnormal physical exam findings who underwent surveillance CT scans, paps and/or CA125 during the 2years pre- and 2years post-SGO guidelines.92 patients (n=48 pre-6/2011, n=44 post-6/2011) were identified. Mean patient age was 58years. No significant difference in age, ethnicity, body mass index, or disease grade or stage was noted. There was a significant decline in surveillance CT scans (n=13, 27% vs. n=4, 9%, p=0.03), CA125 (n=14, 29% vs. 5, 11%, p=0.035) and paps (n=34, 71% vs. n=8 vs. 18%, p<0.001). There was no significant difference in disease status at the last follow-up. Institutional cost of surveillance also declined ($14,102.46 2years pre-guidelines, $3,054.99 2years post-guidelines).RESULTS92 patients (n=48 pre-6/2011, n=44 post-6/2011) were identified. Mean patient age was 58years. No significant difference in age, ethnicity, body mass index, or disease grade or stage was noted. There was a significant decline in surveillance CT scans (n=13, 27% vs. n=4, 9%, p=0.03), CA125 (n=14, 29% vs. 5, 11%, p=0.035) and paps (n=34, 71% vs. n=8 vs. 18%, p<0.001). There was no significant difference in disease status at the last follow-up. Institutional cost of surveillance also declined ($14,102.46 2years pre-guidelines, $3,054.99 2years post-guidelines).In a single urban academic public hospital, after only 2years, clinical adherence to the 2011 SGO endometrial cancer surveillance guidelines resulted in a significant decline in the use of CT scans, CA125 and paps. This reduction does not appear to affect patient outcomes and led to an appreciable decrease in surveillance costs.CONCLUSIONSIn a single urban academic public hospital, after only 2years, clinical adherence to the 2011 SGO endometrial cancer surveillance guidelines resulted in a significant decline in the use of CT scans, CA125 and paps. This reduction does not appear to affect patient outcomes and led to an appreciable decrease in surveillance costs.
Author	Philips, Sarah Schwartz, Zachary P. Frey, Melissa K. Curtin, John P.
Author_xml	– sequence: 1 givenname: Zachary P. surname: Schwartz fullname: Schwartz, Zachary P. email: ZPSchwartz.MD@gmail.com organization: New York University School of Medicine, Department of Obstetrics and Gynecology, 550 First Ave., NBV 9E2, New York, NY 10016, United States – sequence: 2 givenname: Melissa K. surname: Frey fullname: Frey, Melissa K. email: Mkf2002@med.cornell.edu organization: Weill Cornell Medicine, Division of Gynecologic Oncology, 525 E. 68th St., Suite J-130, New York, NY 10065, United States – sequence: 3 givenname: Sarah orcidid: 0000-0003-3197-779X surname: Philips fullname: Philips, Sarah email: SarahRPhilips@gmail.com organization: New York University School of Medicine, 550 1st Ave., New York, NY 10016, United States – sequence: 4 givenname: John P. surname: Curtin fullname: Curtin, John P. email: John.Curtin@nyumc.org organization: New York University School of Medicine, Division of Gynecologic Oncology, 550 First Ave., NBV 9E2, New York, NY 10016, United States
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Cites_doi	10.1016/j.ygyno.2006.05.013 10.1177/030089161109700502 10.1097/AOG.0000000000001293 10.1016/j.ygyno.2017.03.022 10.6004/jnccn.2009.0035 10.1097/IGC.0000000000000797 10.2217/fon.14.192 10.6004/jnccn.2014.0025 10.1016/j.ygyno.2006.02.011 10.1016/j.ajog.2011.03.008 10.1111/IGC.0b013e3181e2abcc
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SubjectTerms	Adherence Adult Aged CA-125 Antigen - blood Cost Cytology Endometrial cancer Endometrial Neoplasms - diagnosis Female Guideline Adherence Health Care Costs Humans Middle Aged Outcomes Papanicolaou Test - economics Papanicolaou Test - utilization Physical Examination Practice Guidelines as Topic Retrospective Studies Surveillance Symptom Assessment Tomography, X-Ray Computed - economics Tomography, X-Ray Computed - utilization Watchful Waiting - economics Watchful Waiting - methods Watchful Waiting - standards
Title	Endometrial cancer surveillance adherence reduces utilization and subsequent costs
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