Who should follow up lung cancer patients after operation?
BACKGROUND
It is unclear whether follow-up by a thoracic surgeon after lung cancer resection alters survival.


METHODS
The charts of 245 early stage (< or = IIB) non-small cell lung cancer patients, diagnosed between 1988 and 1995, were reviewed. Follow-up data were complete to January 1, 1997, in 96.3% (236 of 245) of cases.


RESULTS
Ninety of the 111 recurrences were detected before discharge from the thoracic clinic. Despite clinic follow-up, 66.7% (60 of 90) were identified by the family physician, and only 28.9% (26 of 90) by the surgeon. The remaining 4.4% (4 of 90) were detected by other physicians. Ninety-six percent (25 of 26) surgeon-detected recurrences had suspicious clinical or chest radiographic findings, compared with 92% for family physician-detected recurrences (55 of 60; not significant). The cost per recurrence detected by surgeons was Can $4,367. A 75% cost savings could ensure if patients were followed up by their family physician. There was no 5-year survival benefit for patients whose recurrence was detected by the surgeon.


CONCLUSIONS
Long-term follow-up after limited-stage non-small cell lung cancer resection could possibly be performed by a family physician alone without compromising overall survival, and with significant cost savings.
Gilbert
S
S
Department of Surgery, Queen's University, Kingston, Ontario, Canada.
Reid
K R
KR
Lam
M Y
MY
Petsikas
D
D
D000328:Adult; D000359:Aftercare / Q000191:economics*; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000191:economics / Q000401:mortality; D009864:Ontario; D010348:Patient Care Team / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics* / Q000401:mortality; D015996:Survival Rate