OBJECTIVE To explore how patients experienced the changed follow-up care for gynaecological cancer during the COVID-19 pandemic and their perspectives on aftercare to identify key elements of follow-up care. DESIGN Qualitative study using thematic analysis. SETTING Focus group discussions and individual interviews conducted in the Netherlands. POPULATION Patients diagnosed with ovarian, cervical, endometrial, or vulvar cancer who received follow-up care during the COVID-19 pandemic. METHODS Transcripts underwent thematic analysis. MAIN OUTCOME MEASURES Evaluate experiences of patients with follow-up during the pandemic and to explore and better understand patient preferences and needs. RESULTS Five themes were generated: 1) continuity of care, 2) absence of family members and carers, 3) meeting my needs, 4) managing my needs, 5) the cancer survivor narrative. The main changes experienced during the COVID-19 pandemic were the introduction to remote healthcare and the absence of family members. An interconnection between themes was found, highlighting that providing a designated, always accessible contact person, can be a catalyst for improving information provision and healthcare guidance. CONCLUSIONS In conclusion, this study highlights the need for personalised and patient-centred follow-up that promotes patient-empowerment, and how this can be provided by a designated contact person. Findings emphasise the importance of tailored support, involvement of family members, addressing information gaps, and overcoming barriers to self-management. Lastly, the findings provide direction on how to approach follow-up care during future periods of scarcity.

Objective To evaluate the influence of intrauterine (IU) or non-IU manipulators on oncological outcome in early-stage, low-grade endometrioid endometrial cancer (EEC). Design Retrospective cohort study Setting Nationwide population-based study in the Netherlands Population Women with FIGO stage I, low-grade EEC who received total laparoscopic hysterectomy between 2010 and 2020. Methods Patient data were identified from the Netherlands Cancer Registry. Data regarding hospital manipulator preferences were retrieved through an online survey. Patients were categorized based on hospital manipulator preference. Survival analyses were performed using univariable and multivariable cox regression analysis. Main outcome measures Recurrence of cancer, disease-free survival (DFS), overall survival (OS), site of recurrence, and manipulator preference according to type of hospital. Results Of the total study population (N = 5,205), 1524 (29.3%) patients underwent surgery in hospitals that used non-IU manipulators and 3681 (70.7%) in hospitals that used IU manipulators. Recurrence of cancer was experienced by 195 patients, 49 (3.2%) in the non-IU group and 146 (4.0%) in the IU group. No significant difference in site of recurrence was observed (p=0.778). After adjusting for potential confounders, type of uterus manipulator did not affect DFS (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.78–1.11) and OS (HR 0.90, 95% CI 0.75–1.09). Conclusion IU manipulators are not inferior to non-IU manipulators with respect to oncological outcome in early-stage, low-grade EEC.

Background: Tumor positivity and upstaging rates from various surgical staging components performed in clinically early-stage epithelial ovarian carcinoma (EOC) vary widely in literature. Objectives: To quantify tumor positivity and upstaging rates for all staging surgery components in EOC patients. Differences between subgroups based on their clinical and histological characteristics are explored. Search strategy: A systematic search using synonyms of ‘ovarian cancer’, ‘neoplasm staging’, and ’neoplasm metastasis’ was conducted in PubMed, Embase, and the Cochrane Library. Selection criteria: Meta-analysis was performed on 23 included studies, comprising 5194 clinical stage I or II EOC patients who underwent comprehensive surgical staging. Data Collection and Analysis: Studies were assessed using the Newcastle-Ottawa Scale risk-of-bias tool. Pooled proportions and 95% confidence intervals were calculated using an inverse variance weighted random-effects model. Main Results: Overall upstaging rate of clinically early-stage EOC patients was 18.7% (95%CI: 14.1-23.4%). Serous histology or high grade EOC showed the highest upstaging rate at 35.3% (95%CI: 21.8-48.7%) and 40.9% (95%CI: 35.6-46.2%). Lymph node involvement resulted in an upstaging rate of 8.7% (95%CI: 6.2-11.3%). Tumor was identified in uterus, cytology, peritoneal biopsies, omentum and appendix in 6.2% (95%CI: 1.8-10.7%), 18.4% (95%CI: 13.8-22.9%), 9.7% (95%CI: 3.8-15.6%), 5.2% (95%CI: 1.7-8.8%) and 3.6% (95%CI: 0.0-7.5%) of EOC patients. The corresponding upstaging rates were 5.9% (95%CI: 1.4-10.4%), 8.5% (95%CI: 1.8-15.2%), 3.5% (95%CI: 1.0-6.0%), 3.9% (95%CI: 1.4-6.3%) and 1.6% (95%CI: 0.0-3.4%), respectively. Conclusion: The attributive value of comprehensive surgical staging in clinically early-stage EOC patients remains substantial, particularly in serous and high grade tumors.