Regular follow-up after curative resection of nonsmall cell lung cancer: a real benefit for patients?
Even though complete resection is regarded as the only curative treatment for nonsmall cell lung cancer (NSCLC), >50% of resected patients die from a recurrence or a second primary tumour of the lung within 5 yrs. It remains unclear, whether follow-up in these patients is cost-effective and whether it can improve the outcome due to early detection of recurrent tumour. The benefit of regular follow-up in a consecutive series of 563 patients, who had undergone potentially curative resection for NSCLC at the University Hospital, was analysed. The follow-up consisted of clinical visits and chest radiography according to a standard protocol for up to 10 yrs. Survival rates were estimated using the Kaplan-Meier analysis method and the cost-effectiveness of the follow-up programme was assessed. A total of 23 patients (6.4% of the group with lobectomy) underwent further operation with curative intent for a second pulmonary malignancy. The regular follow-up over a 10-yr period provided the chance for a second curative treatment to 3.8% of all patients. The calculated costs per life-yr gained were 90,000 Swiss Francs. The cost-effectiveness of the follow-up protocol was far above those of comparable large-scale surveillance programmes. Based on these data, the intensity and duration of the follow-up was reduced.
Egermann
U
U
Dept of Internal Medicine, Institute of Pathology, University Hospital, Basel, Switzerland.
Jaeggi
K
K
Habicht
J M
JM
Perruchoud
A P
AP
Dalquen
P
P
Solèr
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000401:mortality* / Q000601:surgery*; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000592:standards*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000191:economics / Q000401:mortality* / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D012044:Regression Analysis; D012086:Reoperation; D012720:Severity of Illness Index; D015996:Survival Rate; D013557:Switzerland; D013997:Time Factors