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Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 57 kB

Date submitted: June 01, 2011

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
For patients with ovarian cancer, what is the comparative effectiveness of surveillance using serum cancer antigen 125 (CA 125) versus standard methods (based on clinical symptoms or signs of disease) to detect or predict the likelihood of disease recurrence for asymptomatic patients in remission after initial treatment and to improve the net health outcome?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
yes
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
Serial measurement of CA 125 versus standard methods (based on clinical symptoms or signs of disease) without serial measurements of CA 125
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
Adult women with ovarian cancer in complete remission after initial treatment.
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
Women diagnosed with early-stage disease (stage I) or advanced (stage II-III) disease
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
Improvements in overall survival and quality of life as a result of the earlier detection of recurrent disease and thus earlier use of potentially effective therapy.
Describe any health-related risks, side effects, or harms that you are concerned about.
Health-related risks/side-effects associated with earlier therapy based on CA 125 levels. Also, if earlier therapy is not more effective than later therapy, then earlier detection of recurrence may lower quality of life by shortening the period without therapy and its side effects without a concomitant increase in survival. Small increases in CA 125 (false positives) can also prompt negative imaging studies, and result in anxiety and radiation exposure.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
yes
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Cancer
AHRQ Priority Populations
  • Women
  • Elderly
Federal Health Care Program
  • Medicaid
  • Medicare

Importance

Describe why this topic is important.
Ovarian cancer is one of the most common gynecologic malignancies and the 5th most frequent cause of cancer death in women.* Overall, approximately 80% of patients diagnosed with ovarian cancer will relapse after initial treatment and may benefit from subsequent therapies.
For some time, CA 125 has been used to detect recurrence of ovarian cancer after primary therapy. The practice in the United States has been to monitor CA 125 every 1-3 months during the first years after primary treatment, on the assumption that earlier detection of disease recurrence will translate into more effective treatment of small-volume disease. Recent published evidence, however, has questioned the value of monitoring patients for disease recurrence with CA 125.

*National Cancer Institute (PDQ®). Ovarian epithelial cancer treatment (2010).
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
This topic was given high priority by a multi-disciplinary stakeholder panel (including patient advocates/representatives) convened to identify and select important research questions on cancer of amenable to systematic or comparative effectiveness reviews. A woman with a rising CA125 concentration, who remains well, without symptoms or other signs of recurrent disease, presents a management dilemma in clinical practice.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
yes
If yes, please explain:
Concerns about CA125 testing and the implications of raised CA125 concentrations are major sources of patient anxiety. There is uncertainty regarding the benefit of early detection of disease recurrence or progression by CA 125. Because of this issue, practice varies in terms of whether or not CA125 is measured regularly following remission and in the initiation of additional therapy when levels rise.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
A report would inform clinical decision-making for patients, payers and providers.
Describe the timeframe in which an answer to your question is needed.
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
Approximately 50% of all ovarian cancer cases occur in women over 65 years of age.

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Other
Are you making a suggestion as an individual or on behalf of an organization?
Organization - BlueCross BlueShield Association Technology Evaluation Center
Please tell us how you heard about the Effective Health Care Program
The BlueCross BlueShield Association Technology Evaluation Center is an Evidence-based Practice Center of AHRQ.