Detection of relapse in early-stage Hodgkin's disease: role of routine follow-up studies.
OBJECTIVE
To examine the costs and benefits of routine follow-up evaluation in patients treated with radiation therapy for early-stage Hodgkin's disease.


METHODS
We retrospectively examined patterns of follow-up evaluation and methods of relapse detection among 709 patients with stage I and II Hodgkin's disease treated with primary radiotherapy between 1969 and 1994. We determined the probability of relapse detection for seven routine follow-up procedures, compared their relative costs, and determined the impact of each procedure on the likelihood of survival following salvage therapy.


RESULTS
Relapse has occurred in 157 patients (22%) at a median 1.9 years (range, 0 to 13 years) posttreatment. Relapse was suspected primarily by history (Hx) in 55% of patients, physical examination (PE) in 14%, chest x-ray (CXR) in 23%, and abdominal x-ray (KUB) in 7%. Only one relapse (1%) was identified by a routine laboratory study. The rate of relapse detection was highest for a combination of Hx and PE (78 of 10,000 examinations) followed by CXR (26 of 10,000 examinations). The projected charges (1995 dollars) per relapse detected by routine follow-up Hx and PE were $11,000 compared with $68,000 for CXR and $142,000 for KUB. The 10-year actuarial survival rate following salvage therapy was 65% overall, 65% for patients in whom relapse was detected by Hx or PE, and 69% for patients in whom relapse was detected by radiographs (P = not significant).


CONCLUSIONS
The majority of relapses occurred within 5 years of treatment and were identified by Hx and PE. CXR was useful during the first 3 years of follow-up evaluation. KUB, CBC, and laboratory studies accounted for nearly half of all follow-up charges and rarely led to the detection of relapse. Their routine use as a method of relapse detection is questionable. In general, the method of relapse detection did not have a significant impact on the likelihood of successful salvage therapy.
Torrey
M J
MJ
Department of Radiation Oncology, Stanford University Medical Center, CA, USA. margaret.torrey@mcrad.med.nyu.edu
Poen
J C
JC
Hoppe
R T
RT
D002140:California; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000191:economics; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006689:Hodgkin Disease / Q000191:economics* / Q000473:pathology / Q000532:radiotherapy; D006785:Hospitals, University; D006801:Humans; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate