The MOST (Measure of Ovarian Symptoms and Treatment concerns) Trial aims to improve patient experience and outcomes by offering more holistic care and relieving the stress of travelling to appointments, particularly for women in rural areas. The randomised controlled trial compares three-monthly follow-up via telehealth with a nurse, with routine follow-up with a specialist at a clinic.
The idea for the trial came about two years ago when lead researcher, St John of God Subiaco hospital Director of Gynaecological Cancer Research Dr Paul Cohen, was conducting a follow-up examination with a patient.
“The patient had travelled from Broome to Perth for the appointment, and had done so for all her three-monthly appointments,” Dr Cohen says.
“She asked me why she had to see me face-to-face, why the consultation couldn’t happen via telehealth as flying and staying in Perth was stressful and inconvenient, especially as she experienced difficulty walking as a side effect of the chemotherapy.”
“So I started to think, maybe it wasn’t necessary. For the thirty percent of ovarian cancer patients who live in rural Australia, as well as those who live in city centres, making follow-up appointments easier and more convenient seemed like something we should be doing.”
After consultation with colleagues, Dr Cohen started to look for evidence to demonstrate the need for regular pelvic examinations post-surgery and chemotherapy.
“There is no good evidence to show that ‘face to face’ appointments improve health outcomes,” Dr Cohen says.
“It is just something we’ve always done without any good evidence to show that it is effective. If we can offer safe and high quality care via telehealth, it would be just as effective, if not more so.”
On completion of chemotherapy, trial patients speak to a nurse, using a patient reported symptom assessment every three months.
They also have their bloodwork tested to monitor a tumour marker, serum CA125, that is part of routine follow-up care. If there is any indication that there are signs of recurrence, the patient is immediately referred for scans and to her specialist.
Nurses ask clinical questions, including those relating to abdominal pain, bloating and swelling, which seem to be predictors of recurrent ovarian cancer. They also ask questions about the patient’s emotional wellbeing and other needs that doctors tend not to enquire about at consultations.
“Psychological issues, such as anxiety and depression, and sexual and body image issues, are often not addressed in the clinic but are very relevant if you are going through cancer,” Dr Cohen says.
“This questionnaire provides the nurse the opportunity to approach patient care more holistically and address any of these concerns with a referral to an appropriate health care professional such as a physiotherapist or a psychologist.”
This study is sponsored by St John of God Subiaco Hospital and has been funded by the WA Health Translation Network, Medical Research Future Fund, ANZGOG Fund for New Research and the Ladybird Foundation.