Is follow-up of lung cancer patients after resection medically indicated and cost-effective?
BACKGROUND
There are no guidelines for the appropriate follow-up of patients after pulmonary resection for lung cancer.


METHODS
Three-hundred fifty-eight consecutive patients who had undergone complete resections of non-small cell lung cancer between 1987 and 1991 were evaluated for tumor recurrence and development of second primary tumors. Recurrences were categorized by site (local or distant), mode of presentation (symptomatic or asymptomatic), treatment given (curative intent or palliative), and duration of overall survival.


RESULTS
Recurrences developed in 135 patients (local only, 32; local and distant, 13; and distant only, 90). Of these, 102 were symptomatic and 33 were asymptomatic (most diagnosed by screening chest roentgenogram). Forty patients received treatment with curative intent (operation or radiation therapy > 50 Gy) and 95 were treated palliatively. The median survival duration from time of recurrence was 8.0 months for symptomatic patients and 16.6 months for asymptomatic patients (p = 0.008). Multivariate analysis shows that disease-free interval (greater than 12 months or less than or equal to 12 months) was the most important variable in predicting survival after recurrence and that mode of presentation, site of recurrence, initial stage, and histologic type did not significantly affect survival. New primary tumors developed in 35 patients.


CONCLUSIONS
Although detection of asymptomatic recurrences gives a lead time bias of 8 to 10 months, mode of treatment and overall survival duration are not greatly affected by this earlier detection. Disease-free interval appears to be the most important determinant of survival. Screening for asymptomatic recurrences in patients who have had lung cancer is unlikely to be cost-effective. Frequent follow-up and extensive radiologic evaluation of patients after operation for lung cancer are probably unnecessary.
Walsh
G L
GL
Department of Thoracic and Cardiovascular Surgery, University of Texas M.D. Anderson Cancer Center, Houston, USA.
O'Connor
M
M
Willis
K M
KM
Milas
M
M
Wong
R S
RS
Nesbitt
J C
JC
Putnam
J B
JB
Lee
J J
JJ
Roth
J A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002283:Carcinoma, Bronchogenic / Q000191:economics / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D003266:Continuity of Patient Care / Q000191:economics; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D010166:Palliative Care; D012189:Retrospective Studies; D015996:Survival Rate