Patients’ preferences for follow-up after endometrial cancer surgery

Authors

  • Linn Renman Department of Obstetrics and Gynecology, Sundsvall County Hospital, Sundsvall, Sweden
  • Lotta Andréen Department of Obstetrics and Gynecology, Sundsvall County Hospital, Sundsvall, Sweden
  • Sahruh Turkmen Department of Obstetrics and Gynecology, Sundsvall County Hospital, Sundsvall, Sweden; Department of Clinical Sciences, Obstetrics and Gynecology, Sundsvall Research Unit, Umeå University, Umeå, Sweden

DOI:

https://doi.org/10.2340/1651-226X.2026.45981

Abstract

Background and purpose: To compare follow-up preferences and health-related quality of life between newly operated endometrial cancer patients and those already enrolled in a traditional hospital-based follow-up program, and to explore whether preferences differ depending on follow-up experience.
Patient/material and methods: In this prospective cross-sectional study, patients who underwent primary surgery for endometrial cancer in northern Sweden were included. Group 1 consisted of newly operated patients recruited before entering follow-up, and Group 2 included patients already participating in the standard hospital-based follow-up program. Participants completed questionnaires on sociodemographic characteristics, follow-up preferences, and quality of life (EORTC QLQ-C30). Clinical data were obtained from medical records. The primary outcome was follow-up preference; secondary outcomes included quality of life and associations with clinical and demographic variables.
Results: Of the 121 invited patients, 92 (76%) responded, and 90 were included in the analysis (48 in Group 1; 42 in Group 2). The groups were comparable in baseline characteristics. Newly operated patients demonstrated more diverse follow-up preferences, with 51.1% preferring physician-led hospital visits compared to 82.9% in Group 2 (p = 0.035). Global quality of life did not differ significantly (p = 0.165), although Group 1 reported lower functional scores, particularly in role and emotional functioning. Appetite loss was the only symptom that differed significantly between groups.
Interpretation: Newly operated patients are more open to alternative follow-up models despite similar overall quality of life. Integrating patient preferences into follow-up care may enhance personalization and sustainability.

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References

Swedish National Board of Health and Welfare (Socialstyrelsen). Nationellt vårdprogram livmoderkroppscancer; 2025. [cited 2026 April 8]. Available from: https://kunskapsbanken.cancercentrum.se/diagnoser/livmoderkroppscancer/vardprogram/

Arnold M, Pandeya N, Byrnes G, Renehan PAG, Stevens GA, Ezzati PM, et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol. 2015;16(1):36–46 DOI: https://doi.org/10.1016/S1470-2045(14)71123-4

Oaknin A, Bosse TJ, Creutzberg CL, Giornelli G, Harter P, Joly F, et al. Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33(9):860–77 DOI: https://doi.org/10.1016/j.annonc.2022.05.009

Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016;387(10023):1094–108 DOI: https://doi.org/10.1016/S0140-6736(15)00130-0

Nagle C, Crosbie E, Brand A, Obermair A, Oehler M, Quinn M, et al. The association between diabetes, comorbidities, body mass index and all-cause and cause-specific mortality among women with endometrial cancer. Gynecol Oncol. 2018;150(1):99-105 DOI: https://doi.org/10.1016/j.ygyno.2018.04.006

Fung-Kee-Fung M, Dodge J, Elit L, Lukka H, Chambers A, Oliver T, Cancer Care Ontario Program in Evidence-based Care Gynecology Cancer Disease Site G. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecol Oncol. 2006;101(3):520–9 DOI: https://doi.org/10.1016/j.ygyno.2006.02.011

Jeppesen MM, Mogensen O, Hansen DG, Iachina M, Korsholm M, Jensen PT. Detection of recurrence in early stage endometrial cancer – the role of symptoms and routine follow-up. Acta Oncol. 2017;56(2):262–9 DOI: https://doi.org/10.1080/0284186X.2016.1267396

Nordin AJ, National Group of Gynaecology NL. Mode of detection of recurrent gynecological malignancy: does routine follow-up delay diagnosis and treatment? Int J Gynecol Cancer. 2006;16(5):1746–8 DOI: https://doi.org/10.1136/ijgc-00009577-200609000-00003

Kew FM, Roberts AP, Cruickshank DJ. The role of routine follow-up after gynecological malignancy. Int J Gynecol Cancer. 2005;15(3):413–9 DOI: https://doi.org/10.1136/ijgc-00009577-200505000-00001

Tjalma WA, van Dam PA, Makar AP, Cruickshank DJ. The clinical value and the cost-effectiveness of follow-up in endometrial cancer patients. Int J Gynecol Cancer. 2004;14(5):931–7 DOI: https://doi.org/10.1136/ijgc-00009577-200409000-00029

Lajer H, Jensen MB, Kilsmark J, Albaek J, Svane D, Mirza MR, et al. The value of gynecologic cancer follow-up: evidence-based ignorance? Int J Gynecol Cancer. 2010;20(8):1307–20.

Zola P, Ciccone G, Piovano E, Fuso L, Di Cuonzo D, Castiglione A, et al. Effectiveness of intensive versus minimalist follow-up regimen on survival in patients with endometrial cancer (TOTEM Study): a randomized, pragmatic, parallel group, multicenter trial. J Clin Oncol. 2022;40(33):3817–27 DOI: https://doi.org/10.1200/JCO.22.00471

Agboola OO, Grunfeld E, Coyle D, Perry GA. Costs and benefits of routine follow-up after curative treatment for endometrial cancer. CMAJ. 1997;157(7):879–86.

Salvesen HB, Akslen LA, Iversen T, Iversen OE. Recurrence of endometrial carcinoma and the value of routine follow up. Br J Obstet Gynaecol. 1997;104(11):1302–7 DOI: https://doi.org/10.1111/j.1471-0528.1997.tb10979.x

Jeppesen MM, Mogensen O, Hansen DG, Bergholdt SH, Jensen PT. How do we follow up patients with endometrial cancer? Curr Oncol Rep. 2019;21(4):30 DOI: https://doi.org/10.1007/s11912-019-0805-3

Sartori E, Pasinetti B, Chiudinelli F, Gadducci A, Landoni F, Maggino T, et al. Surveillance procedures for patients treated for endometrial cancer: a review of the literature. Int J Gynecol Cancer. 2010;20(6):985–92 DOI: https://doi.org/10.1111/IGC.0b013e3181e2abcc

Beaver K, Williamson S, Sutton C, Hollingworth W, Gardner A, Allton B, et al. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG. 2017;124(1):150–60 DOI: https://doi.org/10.1111/1471-0528.14000

Smits A, Lopes A, Das N, Bekkers R, Kent E, McCullough Z, et al. Telephone follow-up: improving options for women with endometrial cancer. Cancer Nurs. 2015;38(3):232–8 DOI: https://doi.org/10.1097/NCC.0000000000000177

Ezendam NPM, de Rooij BH, Creutzberg CL, Kruitwagen R, van Lonkhuijzen L, Apperloo MJA, et al. Effect of reduced follow-up care on patient satisfaction with care among patients with endometrial cancer: the ENSURE randomized controlled trial. Gynecol Oncol. 2024;188:169–83 DOI: https://doi.org/10.1016/j.ygyno.2024.06.020

Jeppesen MM, Jensen PT, Hansen DG, Christensen RD, Mogensen O. Patient-initiated follow up affects fear of recurrence and healthcare use: a randomised trial in early-stage endometrial cancer. BJOG. 2018;125(13):1705–14 DOI: https://doi.org/10.1111/1471-0528.15396

Rulanda MC, Mogensen O, Jensen PT, Hansen DG, Wu C, Jeppesen MM. Patient-initiated follow-up in women with early-stage endometrial cancer: a long-term follow-up of the OPAL trial. BJOG. 2023;130(13):1593–601 DOI: https://doi.org/10.1111/1471-0528.17567

Coleridge S, Morrison J. Patient-initiated follow-up after treatment for low risk endometrial cancer: a prospective audit of outcomes and cost benefits. Int J Gynecol Cancer. 2020;30(8):1177–82 DOI: https://doi.org/10.1136/ijgc-2020-001263

Kumarakulasingam P, McDermott H, Patel N, Boutler L, Tincello DG, Peel D, et al. Acceptability and utilisation of patient-initiated follow-up for endometrial cancer amongst women from diverse ethnic and social backgrounds: a mixed methods study. Eur J Cancer Care (Engl). 2019;28(2):e12997 DOI: https://doi.org/10.1111/ecc.12997

Leitch M, Arshad A, Cohen PA, Allanson ER. Patient-initiated follow-up in low-risk endometrial cancer after surgery: a systematic review. Int J Gynecol Cancer. 2025;35(2):100037 DOI: https://doi.org/10.1016/j.ijgc.2024.100037

Beaver K, Williamson S, Sutton CJ, Gardner A, Martin-Hirsch P. Endometrial cancer patients’ preferences for follow-up after treatment: a cross-sectional survey. Eur J Oncol Nurs. 2020;45:101722 DOI: https://doi.org/10.1016/j.ejon.2020.101722

Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76 DOI: https://doi.org/10.1093/jnci/85.5.365

Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105(2):103–4 DOI: https://doi.org/10.1016/j.ijgo.2009.02.012

Hendrix JM, Garmon EH. American Society of Anesthesiologists physical status classification system. Treasure Island, FL: StatPearls; 2025.

Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, et al. The EORTC QLQ-C30 scoring manual. Brussels: European Organisation for Reserach and Treatment of Cancer; 2001.

Beaver K, Martin-Hirsch P, Williamson S, Kyrgiou M. Exploring the acceptability and feasibility of patient-initiated follow-up for women treated for stage I endometrial cancer. Eur J Oncol Nurs. 2020;44:101704 DOI: https://doi.org/10.1016/j.ejon.2019.101704

Sharma T, Sharma S, Eastwood J, Jackson R, Wells J. Patient satisfaction with patient-led follow-up for endometrial cancer. Br J Nurs. 2020;29(17):s4–10 DOI: https://doi.org/10.12968/bjon.2020.29.17.S4

Dretzke J, Lorenc A, Adriano A, Herd C, Mehanna H, Nankivell P, et al. Systematic review of patients’ and healthcare professionals’ views on patient-initiated follow-up in treated cancer patients. Cancer Med. 2023;12(15):16531–47 DOI: https://doi.org/10.1002/cam4.6243

Ferrandina G, Petrillo M, Mantegna G, Fuoco G, Terzano S, Venditti L, et al. Evaluation of quality of life and emotional distress in endometrial cancer patients: a 2-year prospective, longitudinal study. Gynecol Oncol. 2014;133(3):518–25 DOI: https://doi.org/10.1016/j.ygyno.2014.03.015

Herling SF, Moller AM, Palle C, Thomsen T. Health-related quality of life after robotic-assisted laparoscopic hysterectomy for women with endometrial cancer – a prospective cohort study. Gynecol Oncol. 2016;140(1):107–13 DOI: https://doi.org/10.1016/j.ygyno.2015.10.024

Lindfors A, Jarvholm S, Dahm-Kahler P. Health-related quality of life after robotic versus open surgery for endometrial cancer. Acta Obstet Gynecol Scand. 2020;99(4):498–506.

Published

2026-07-27

How to Cite

Renman, L., Andréen, L., & Turkmen, S. (2026). Patients’ preferences for follow-up after endometrial cancer surgery. Acta Oncologica, 65, 624–631. https://doi.org/10.2340/1651-226X.2026.45981