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Women in the intervention group were instructed in patient\u2010initiated follow up, which included careful instruction in alarm symptoms and options for self\u2010referral rather than a schedule of examinations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>The primary end point was <jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content> as measured by the Fear of Cancer Recurrence Inventory (<jats:styled-content style=\"fixed-case\">FCRI<\/jats:styled-content>) after 10\u00a0months of follow up. Secondary end points included cancer\u2010related use of primary and secondary health care during the first 10\u00a0months after treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the primary analysis, <jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content> decreased significantly more in the control group from baseline to 10\u00a0months of follow up (difference \u22125.9, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u221210.9 to \u22120.9). The majority of this improvement happened after only 3\u00a0months of follow up. Women receiving the intervention had fewer examinations at the department compared with the control group (0 versus 2 median visits, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) and 58% of these examinations were scheduled because of vaginal bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hospital\u2010based follow up alleviates <jats:styled-content style=\"fixed-case\">FCR<\/jats:styled-content> significantly more than patient\u2010initiated follow up, though the estimated difference was small. Patient\u2010initiated follow up is a feasible, potentially cost\u2010reducing follow\u2010up approach in a population of endometrial cancer survivors with low risk of recurrence. The decision to use patient\u2010initiated follow up should balance these benefits and harms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Patient\u2010initiated follow up reduces healthcare\u00a0use but maintains fear of recurrence in endometrial cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Plain Language Summary<\/jats:title><jats:sec><jats:title>Why and how was the study carried out?<\/jats:title><jats:p>Follow up of women with endometrial cancer is resource consuming and previous research suggests that it is not effective. Even though the women benefit from reassurance at follow up, routine examinations may also remind the women of the disease and induce fear of cancer recurrence. Furthermore, routine follow up may delay recurrence diagnosis, because the women do not report their symptoms until the next scheduled visit. In the research explained in this article, patient\u2010initiated follow up was evaluated as an alternative to traditional follow up. The women were randomly assigned to one of two follow\u2010up programmes: regular gynaecological examinations at the department of gynaecology or self\u2010referral with careful instruction in alarm symptoms, that is, patient\u2010initiated follow up. The level of fear of cancer recurrence in the two groups was obtained by questionnaires. Information on healthcare use was obtained by questionnaires and a chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>What were the main findings?<\/jats:title><jats:p>Regular examinations at the department of gynaecology reduced the fear of cancer recurrence significantly more than patient\u2010initiated follow up, though the difference was small. Women who were instructed in alarm symptoms, under self\u2010referral, were able to monitor their symptoms, and this approach significantly reduced the number of examinations at the department of gynaecology.<\/jats:p><\/jats:sec><jats:sec><jats:title>What are the limitations of the work?<\/jats:title><jats:p>Participants in the self\u2010referral group knew that they were examined less than other women, and this may have induced fear of cancer recurrence. Similarly, the regular completion of questionnaires regarding fear of cancer recurrence may have reminded the women of the disease and diminished the difference between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>What are the implications for patients<\/jats:title><jats:p>Patient\u2010initiated follow up reduced healthcare use but maintained fear of cancer recurrence in women who had survived early\u2010stage endometrial cancer. Future analyses on quality of life and cost\u2010effectiveness are needed to balance the benefits and harms of patient\u2010initiated follow up.<\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1471-0528.15396","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T08:39:33Z","timestamp":1530866373000},"page":"1705-1714","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Patient\u2010initiated follow up affects fear of recurrence and healthcare use: a randomised trial in early\u2010stage endometrial cancer"],"prefix":"10.1111","volume":"125","author":[{"given":"MM","family":"Jeppesen","sequence":"first","affiliation":[{"name":"Department of Gynaecology and Obstetrics Odense University Hospital Odense Denmark"},{"name":"Department of Clinical Research University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PT","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics Odense University Hospital Odense Denmark"},{"name":"Department of Clinical Research University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DG","family":"Hansen","sequence":"additional","affiliation":[{"name":"The National Research Centre of Cancer Rehabilitation Research Unit of General Practice University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RD","family":"Christensen","sequence":"additional","affiliation":[{"name":"Research Unit of General Practice University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Mogensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Research University of Southern Denmark Odense Denmark"},{"name":"The Pelvic Cancer Patient Area Karolinska University Hospital and the Karolinske Institute Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,6]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"1307","article-title":"The value of gynecologic cancer follow\u2010up: evidence\u2010based ignorance?","volume":"20","author":"Lajer H","year":"2010","journal-title":"Int J Gynecol Cancer"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443610802646801"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2011.06.027"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1438.1999.99072.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-013-0272-z"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2006.08.036"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2012.12.013"},{"key":"e_1_2_8_9_1","first-page":"1","article-title":"Detection of recurrence in early stage endometrial cancer\u00a0\u2013\u00a0the role of symptoms and routine follow\u2010up","volume":"12","author":"Jeppesen MM","year":"2017","journal-title":"Acta Oncol Stockh Swed"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1438.2006.00670.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2017.01.025"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.12533"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2008.12.011"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-008-0444-y"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-015-0424-4"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.2070"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-015-1088-2"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200012150-00014"},{"key":"e_1_2_8_19_1","unstructured":"CullA SpangersM BjordalK.On Behalf of the EORTC Quality of Life Study Group:Translation Procedure. 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