TABLE III.

Summary of recommendations

Domain	Recommendations
Follow-up after treatment
	■ The optimal method of follow-up has not been established, but possible options and the implications and consequences of those options should be discussed with the woman at the completion of primary treatment.
	■ Consideration should be given to how anxiety might be lessened, such as scheduling tests before the visit so that test results are available for discussion at the time of the follow-up visit.
CA125 in follow-up
	■ A time should be provided for the woman and her clinician to discuss the implications of monitoring progress and initiating treatment based on serum CA125. Women who choose to have serum CA125 measured should be informed that there is no evidence that monitoring CA125 improves survival outcomes, that monitoring could worsen quality of life15, and that CA125 can fluctuate because of individual and laboratory assay variations. The implications of a stable, fluctuating, and rising level should be discussed.
Timing of follow-up consultations
	■ Discussion with the woman about follow-up could incorporate a schedule of follow-up appointments, including the possibility of no formal follow-up schedule, based on the identified needs and wishes of the individual.
	■ There is no recommended frequency of follow-up consultations, but a clear and mutually agreed arrangement should be negotiated with the woman, tailored according to risk and to individual patient characteristics, thus acknowledging the benefits of an ongoing relationship and the opportunity to deal with issues as they arise.
	■ Women residing in rural and regional areas face additional challenges of access to specialist clinicians for follow-up appointments. Individual circumstances should be considered when establishing a follow-up schedule.
Format for follow-up consultations
	■ The basic format of consultation is to update the patient history, assess psychosocial and supportive care needs, and undertake physical examination, which can include pelvic examination.
	■ Women should be encouraged to report a range of symptoms, including nausea, vomiting, abdominal distension, cramping, pain, shortness of breath, and any other concerning symptom.
	■ Radiologic imaging should not routinely be done, but should be performed in the presence of clinical or CA125 evidence of recurrence. The rationale for not undertaking routine imaging should be discussed with the woman.
Models of follow-up care
	■ A woman can be reviewed by either a gynecologic oncologist or a medical oncologist. Communication with a woman’s primary care physician should be maintained throughout follow-up.
	■ The use of alternative models of care for women with ovarian cancer, such as follow-up led by the primary care physician or nurse, telephone follow-up, and patient-initiated care is an area for future research. Some of the issues that would have to be addressed in any future studies include patient and clinician preferences, the effectiveness and cost effectiveness of the alternative models, and the ability of health services to support the models.