MedicalResearch.com Interview with:
Katharine Mckinley Esselen, M.D.
Instructor in Obstetrics, Gynecology and Reproductive Biology
Beth Israel Deaconess Medical Center
Brigham and Womens Hospital
MedicalResearch.com: What is the background for this study?
Response: There is no consensus on how to follow a patient in remission from ovarian cancer in order to detect recurrent disease. However, a 2009 randomized clinical trial demonstrated that using CA-125 blood tests for routine surveillance in ovarian cancer increases the use of chemotherapy and decreases patient’s quality of life without improving survival compared with clinical observation. Published guidelines categorize CA-125 tests as optional and discourage the use of radiographic imaging for routine surveillance. Thus, this study aims to examine the use of CA-125 tests and CT scans at 6 Cancer Centers and to estimate the economic impact of this surveillance testing for ovarian cancer.
MedicalResearch.com: What are the main findings?
Response: CA-125 tests and CT scans are routinely used in ovarian cancer surveillance testing and their use did not change in response to the randomized clinical trial suggesting no survival benefit to testing and possible harm to patients with increased chemotherapy and decreased quality of life. Monetary costs associated with surveillance testing are largely driven by use of CT scans.
MedicalResearch.com: What should readers take away from your report?
Response: 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 with it. For example, 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.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
1) While routine CA-125 testing did not improve survival, the 2009 study did not measure other potentially important benefits or drawbacks of a CA-125 test. Thus, it would be important to evaluate what patients and providers value about the CA-125 test.
2) There is limited data evaluating the role of CT scans in ovarian cancer surveillance. Therefore, a prospective study of the use of CT scans in ovarian cancer surveillance to assess their impact on survival and associated costs would lead to improved valuation of these tests.
MedicalResearch.com: Is there anything else you would like to add?
Response: The decision to perform a CA-125 test or CT scan in surveillance testing for ovarian cancer remains a highly individualized decision between a patient and her provider. While there is one large randomized study suggesting no benefit of routine CA-125 surveillance there may be unmeasured benefits to the patient and provider that are not well understood. For this reason, its use should be carefully reviewed with the patient so that they can come to the best decision for themselves.
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