Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisReviewForskningpeer review

DOI

  • Garth Funston, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. gf272@cam.ac.uk.
  • ,
  • Marije Van Melle, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • ,
  • Marie-Louise Ladegaard Baun
  • Henry Jensen
  • Charles Helsper, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.
  • ,
  • Jon Emery, Professor of Primary Care Cancer Research, Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Australia.
  • ,
  • Emma J Crosbie, Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Manchester, UK.
  • ,
  • Matthew Thompson, Department of Family Medicine, University of Washington, Seattle, USA.
  • ,
  • Willie Hamilton, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
  • ,
  • Fiona M Walter, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.

BACKGROUND: Women with ovarian cancer can present with a variety of symptoms and signs, and an increasing range of tests are available for their investigation. A number of international guidelines provide advice for the initial assessment of possible ovarian cancer in symptomatic women. We systematically identified and reviewed the consistency and quality of these documents.

METHODS: MEDLINE, Embase, guideline-specific databases and professional organisation websites were searched in March 2018 for relevant clinical guidelines, consensus statements and clinical pathways, produced by professional or governmental bodies. Two reviewers independently extracted data and appraised documents using the Appraisal for Guidelines and Research Evaluation 2 (AGREEII) tool.

RESULTS: Eighteen documents from 11 countries in six languages met selection criteria. Methodological quality varied with two guidance documents achieving an AGREEII score ≥ 50% in all six domains and 10 documents scoring ≥50% for "Rigour of development" (range: 7-96%). All guidance documents provided advice on possible symptoms of ovarian cancer, although the number of symptoms included in documents ranged from four to 14 with only one symptom (bloating/abdominal distension/increased abdominal size) appearing in all documents. Fourteen documents provided advice on physical examinations but varied in both the examinations they recommended and the physical signs they included. Fifteen documents provided recommendations on initial investigations. Transabdominal/transvaginal ultrasound and the serum biomarker CA125 were the most widely advocated initial tests. Five distinct testing strategies were identified based on the number of tests and the order of testing advocated: 'single test', 'dual testing', 'sequential testing', 'multiple testing options' and 'no testing'.

CONCLUSIONS: Recommendations on the initial assessment and investigation for ovarian cancer in symptomatic women vary considerably between international guidance documents. This variation could contribute to differences in the way symptomatic women are assessed and investigated between countries. Greater research is needed to evaluate the assessment and testing approaches advocated by different guidelines and their impact on ovarian cancer detection.

OriginalsprogEngelsk
Artikelnummer1028
TidsskriftBMC Cancer
Vol/bind19
Nummer1
ISSN1471-2407
DOI
StatusUdgivet - 1 nov. 2019

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