Abstract
Gynaecological cancers account for 10% of cancers diagnosed in New Zealand. With a growing number of cancer survivors there is an increasing need for evidence-based follow-up recommendations to optimise detection of recurrence and patient outcomes. The primary objective was to investigate how recurrences are detected. The secondary objective was to assess recurrence rates of gynaecological cancer in Otago and Southland regions.
This retrospective cohort study was conducted by identifying patients with recurrent gynaecological cancers from the Gynae/Oncology Follow Up Database, which contains 800 patients, that were diagnosed between 2013 to 2024 in the Otago and Southland region. Patient records were used to complete and cross reference the data. Information about symptoms, and recurrence detection were collected. Descriptive statistics were used to analyse data.
A total of 72 patients with recurrence were identified, 41 were symptomatic, 31 were asymptomatic at the time of recurrence detection. Median time to recurrence was 21 months from diagnosis (range 3 months to 205 months). Among the symptomatic patients, 51.2% of recurrences were detected in the context of routine surveillance clinic visits. 14.6% presented to the Emergency Department. The most common symptom was pain (48.8%). In asymptomatic patients, 51.6% were identified through clinical exam at routine follow-up. Majority of symptomatic patients had regional or distant recurrences (78%). In contrast, 51.6% of asymptomatic patients had local recurrences. 38.9% of all patients in this cohort died in the first year after their recurrence was detected. Recurrence rates were consistent with those reported in international research.
These findings suggest that there is value in routine follow up in patients, especially for early detection of local disease which is often curable. Future studies should compare patient-initiated symptom based follow up versus routine surveillance to establish ideal follow-up regimes.