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Variation in gynecological oncology follow-up ractice: attributable to cancer centers or to patient characteristics? A Piedmont Regional Oncology Network Study

Abstract

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.

Tumori 2011; 97(5): 551 - 558

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.1700/989.10710

Authors

Luca Fuso, Andrea Evangelista, Eva Pagano, Elisa Piovano, Stefania Perotto, Simona Mazzola, Emiliana Bertoldo, Maria Rosa La Porta, Claudia Rosmino, Graziella Furbatto, Sergio Abate, Gianna Di Costanzo, Gianfranco Trossarelli, Maria Grazia Baù, Flavio Carnino, Giuseppina Gambaro, Paola Piantanida, Oscar Alabiso, Luciano Galletto, Laura Zavallone, Annalisa Rossi, Maggiorino Barbero, Maria Tessa, Dionyssios Katsaros, Saverio Danese, Paola Brignolo, Gabriella Gorzegno, Raffaella Grillo, Giovanni Apolone, Giovannino Ciccone, Paolo Zola on behalf of the Piedmont Oncology Network, Italy

Article History

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Authors

  • Fuso, Luca [PubMed] [Google Scholar]
    Gynecology and Obstetrics Academic Department, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
  • Evangelista, Andrea [PubMed] [Google Scholar]
    Unit of Cancer Epidemiology, Azienda Ospedaliera US Giovanni Battista, CPO Piemonte, CeRMS, Turin, Italy
  • Pagano, Eva [PubMed] [Google Scholar]
    Unit of Cancer Epidemiology, Azienda Ospedaliera US Giovanni Battista, CPO Piemonte, CeRMS, Turin, Italy
  • Piovano, Elisa [PubMed] [Google Scholar]
    Gynecology and Obstetrics Academic Department, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
  • Perotto, Stefania [PubMed] [Google Scholar]
    Gynecology and Obstetrics Academic Department, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
  • Mazzola, Simona [PubMed] [Google Scholar]
    Gynecology and Obstetrics Academic Department, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
  • Bertoldo, Emiliana [PubMed] [Google Scholar]
    Medical Oncology, Ospedale Civico di Chivasso, Chivasso, Italy
  • La Porta, Maria Rosa [PubMed] [Google Scholar]
    Radiotherapy, Ospedale di Ivrea, Ivrea, Italy
  • Rosmino, Claudia [PubMed] [Google Scholar]
    Radiotherapy, Ospedale San Giovanni Antica Sede, Turin, Italy
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    Gynecology and Obstetrics, Ospedale di Vercelli, Vercelli, Italy
  • Abate, Sergio [PubMed] [Google Scholar]
    Gynecology and Obstetrics, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
  • Di Costanzo, Gianna [PubMed] [Google Scholar]
    Medical Oncology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
  • Trossarelli, Gianfranco [PubMed] [Google Scholar]
    Gynecology and Obstetrics Academic Department, San Luigi Gonzaga, Orbassano, Italy
  • Baù, Maria Grazia [PubMed] [Google Scholar]
    Gynecology and Obstetrics, Azienda Ospedaliera OIRM-Sant’Anna, Turin, Italy
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    Gynecology and Obstetrics, Ospedale Martini, Turin, Italy
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    Radiotherapy, Ospedale Maggiore della Carità, Novara, Italy
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    Gynecology and Obstetrics, Ospedale Maggiore della Carità, Novara, Italy
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    Medical Oncology, Ospedale Maggiore della Carità, Novara, Italy
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    Gynecology and Obstetrics, Ospedale Civile Edoardo Agnelli, Pinerolo, Italy
  • Zavallone, Laura [PubMed] [Google Scholar]
    Medical Oncology, Ospedale degli Infermi, Biella, Italy
  • Rossi, Annalisa [PubMed] [Google Scholar]
    Radiotherapy, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
  • Barbero, Maggiorino [PubMed] [Google Scholar]
    Gynecology and Obstetrics, Ospedale Cardinal Massaia, Asti, Italy
  • Tessa, Maria [PubMed] [Google Scholar]
    Radiotherapy, Ospedale Cardinal Massaia, Asti, Italy
  • Katsaros, Dionyssios [PubMed] [Google Scholar]
    Gynecology and Obstetrics Academic Department, Azienda Ospedaliera OIRM-Sant’Anna, Turin, Italy
  • Danese, Saverio [PubMed] [Google Scholar]
    Gynecology and Obstetrics, Azienda Ospedaliera OIRM-Sant’Anna, Turin, Italy
  • Brignolo, Paola [PubMed] [Google Scholar]
    Medical Oncology, Ospedale Gradenigo, Turin, Italy
  • Gorzegno, Gabriella [PubMed] [Google Scholar]
    Medical Oncology, San Luigi Gonzaga, Orbassano, Italy
  • Grillo, Raffaella [PubMed] [Google Scholar]
    Medical Oncology, Centro Oncologico ed Ematologico Subalpino, Azienda Ospedaliera San Giovanni Battista, Turin, Italy
  • Apolone, Giovanni [PubMed] [Google Scholar]
    Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
  • Ciccone, Giovannino [PubMed] [Google Scholar]
    Unit of Cancer Epidemiology, Azienda Ospedaliera US Giovanni Battista, CPO Piemonte, CeRMS, Turin, Italy
  • Zola on behalf of the Piedmont Oncology Network, Italy, Paolo [PubMed] [Google Scholar]
    Gynecology and Obstetrics Academic Department, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy

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