Development of an evidence-based symptom checklist for symptoms of recurrence in women with endometrial cancer.

Objective: Women treated for endometrial cancer commonly attend clinic-based follow-up for up to five years even though there is evidence of discrepancies on effectiveness of this approach to improve survival. Furthermore, recent guidelines recommend patient education be the cornerstone for follow-up practices rather than clinical investigations such as medical imaging and tumor markers as prompt and thorough investigations of symptoms are more likely to improve survival. This current practice is based on little evidence and thus alternative models need to be investigated. The overall aim of the study is to identify currently available symptom checklists, determine the comprehensiveness of identified checklists, and generate an updated list of symptoms potentially associated with a recurrence for future testing that will lead to early recurrence detection ultimately improving survival. This paper also explores the definition of recurrence, determines recurrence rates, and identifies post treatment surveillance schedules in reviewed studies. Methods/materials: We conducted a systematic review of the literature extracting; routine follow-up schedules; proportion of patients with symptomatic or asymptomatic recurrence; symptoms of recurrence; prevalence of these symptoms at recurrence. Results: Overall, three previous checklists, and 12 retrospective studies were identified meeting the selection criteria. The average rate of recurrence across the studies was 13% (range 3%-19%). The proportion of patients identified with a symptomatic recurrence varied widely (overall average 67%; range 41% to 91%). The most commonly reported symptoms were vaginal bleeding (25%), pain [not further described] (16%) and abdominal pain and discomfort and swelling (15%) which combined, represented 56% of the total reported symptoms. The three previous checklists listed 14 and this review identified an additional 24 symptoms (e.g. vaginal discharge, extremity/bone pain and constipation) not previously identified. Conclusion: The newly developed symptom checklist expands previous ones and will be used in a prospective study to assess sensitivity and specificity to identify recurrence compared to current standard follow-up examinations. Upon completion of successful testing in a prospective study, it could potentially provide an alternative form of follow-up to the traditional surveillance method to detect recurrences in endometrial cancer survivors.