Patient-initiated follow-up in low-risk endometrial cancer after surgery: a systematic review

Objectives To evaluate the impact of patient initiated follow-up in surgically treated early stage endometrial cancer on quality of life, survival, and health care costs in patients with low risk early stage endometrial cancer. Methods We searched the Cochrane Centre Register of Controlled trials, MEDLINE, Embase, LILACS and CINAHL databases up to 24th August 2024. Inclusion criteria were randomized controlled trials, cohort studies and observational studies that included women aged >18 with Stage 1A, Grade 1 and 2 endometrial cancers as per FIGO 2009 staging criteria, who underwent surgery as their primary treatment and did not require adjuvant therapy. Included studies were those that assessed the impact of patient initiated follow-up in low risk endometrial cancer. The primary outcome was quality of life. Secondary outcomes were overall survival, cancer-specific survival, recurrence free survival, cost/healthcare utilization, and adverse events. Data were extracted and the evidence synthesised. Results Six studies with a total of 1081 participants matched the selection criteria and were included. There was one multi-center randomized controlled trial and 5 cohort studies. Patient initiated follow-up had no impact on fear of cancer recurrence in one study, and quality of life, assessed in two studies, was acceptable. In 5 studies that included 853 patients and a median follow-up between 10 - 60.7 months, there were 22 recurrences and overall survival was 93 - 100%. Conclusion Patient initiated follow-up may be a viable mode of surveillance for patients with low risk endometrial cancer and appears to have little impact on quality of life. Evidence for the impact of patient initiated follow-up on survival on this patient population is lacking. Large randomized controlled trials are needed to assess long-term outcomes.