title: Postradiotherapy surveillance practice for head and neck squamous cell carcinoma--too much for too little?
abstract: BACKGROUND
  Limited information is available regarding surveillance patterns after head and neck cancer radiotherapy. We cataloged follow-up for a specified patient cohort treated at three neighboring university, community, and Veterans Administration institutions.
  
  
  METHODS
  One hundred fifteen patients were treated with curative intent between 1994-1998 with definitive or postoperative radiotherapy for newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx. One hundred patients had continuous follow-up at their treating institution and were included for analysis. Median follow-up until disease recurrence or censorship was 28.5 months.
  
  
  RESULTS
  Median follow-up frequency was 5.7 visits/year and was highly variable. Although visit frequency correlated with disease stage and the presence of high-risk disease features, this association was lost when patients with early recurrences were removed from analysis. Procedure and test utilization closely mirrored visit frequency, resulting in a wide range of estimated yearly charges (0-15,668 dollars/year; median, 1,772 dollars/year). Actuarial 3-year overall survival for the study group was 71%. Eighty-six percent (19 of 22) of potentially salvageable locoregional failures were discovered secondary to symptomatic complaint rather than by test results. Disease failure, whether detected by symptom or testing, predicted for poor survival (22% at 24 months after recurrence).
  
  
  CONCLUSIONS
  Postradiotherapy surveillance for head and neck cancer is inconsistently pursued. A proven correlation between intensive follow-up and improved patient survival is lacking. Surveillance directed by patient symptoms should be investigated as an alternative approach.
authors.affiliation: Department of Radiation Oncology, Seattle VA/PSHCS, 1660 S. Columbian Way [174], Seattle, Washington, 98108, USA. docdls@u.washington.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Schwartz
authors.forename: Jerry
authors.initials: J
authors.lastname: Barker
authors.forename: Kari
authors.initials: K
authors.lastname: Chansky
authors.forename: Bevan
authors.initials: B
authors.lastname: Yueh
authors.forename: Leila
authors.initials: L
authors.lastname: Raminfar
authors.forename: Pamela
authors.initials: P
authors.lastname: Drago
authors.forename: Christine
authors.initials: C
authors.lastname: Cha
authors.forename: Mary
authors.initials: M
authors.lastname: Austin-Seymour
authors.forename: George E
authors.initials: GE
authors.lastname: Laramore
authors.forename: Allen D
authors.initials: AD
authors.lastname: Hillel
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Weymuller
authors.forename: Kent E
authors.initials: KE
authors.lastname: Wallner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000473:pathology / Q000532:radiotherapy*; D003362:Cost-Benefit Analysis; D005251:Fees, Medical; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000191:economics / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012189:Retrospective Studies