Shunning Unnecessary CA-125 and CT Testing in Ovarian Cancer Care Could Improve QOL and Lower Costs

A new health services study in JAMA Oncology evaluated the impact of clinical evidence on routine surveillance in ovarian cancer, and found none.

The clinical study published back in 2009 questioned whether CA-125 was appropriate and necessary for routine surveillance in 529 women who were in remission following treatment for ovarian cancer. The patients regularly (every 3 months) received CA-125 testing, and patients whose test results exceeded twice normal received “early” (soon after notification of elevated CA-125) or “delayed” (5 months after identification of elevated CA-125) treatment. The outcome—no difference in median survival between the 2 groups: 25.7 months (early) versus 27.1 months (delayed).

Significantly women in the delayed treatment group received fewer rounds of chemotherapy and their time to deterioration or death was significantly longer. Importantly, these women had an extra 5 months in remission after their initial treatment.

The Society of Gynecologic Oncology guidelines also recommend CA-125 testing as optional and discourage the use of radiographic imaging for routine surveillance.

In the current study, the authors examined whether these results and recommendations had changed physician behavior and clinical practice, and the economic impact of the testing. The study enrolled 1241 women with ovarian cancer in clinical remission in a prospective study. The women had undergone cytoreductive surgery and chemotherapy at 6 National Cancer Institute—designated cancer centers between 2004 and 2011. They were followed through 2012 to understand use of CA-125 and CT scans before and after the 2009 surveillance data.

The authors observed no change in the use of either surveillance tools during their study period. Cumulatively, 86% of patients had 3 or more CA-125 tests between 2004 and 2009, and the number rose to 91% between 2010 and 2012 (P = .95). Patients with 1 or more CT scans was a cumulative 81% between 2004 and 2009, compared with 78% during 2010 to 2012 (P = .50).

“During a 12-month period, there was a mean of 4.6 CA-125 tests and 1.7 CT scans performed per patient, resulting in a US population surveillance cost estimate of $1,999,029 per year for CA-125 tests alone and $16,194,647 per year with CT scans added,” the authors report.

The study’s lead author Katherine Esselen, MD, MBA, told Reuter’s Health, “If women around the country are getting similar testing, it may cost more than $16 million annually and it’s not clear that this is high-value care.”

Reference

Esselen KM, Cronin AM, Bixel K, et al. Use of CA-125 tests and computed tomographic scans for surveillance in ovarian cancer [published online July 21, 2016]. JAMA Oncol. doi: 10.1001/jamaoncol.2016.1842.