Evidence Based Medicine (EBM) and Evidence Based Radiology (EBR) in the follow-up of the patients after surgery for lung and colon-rectal carcinoma.
OBJECTIVE
A) To define the role of diagnostic imaging modalities in the follow-up of patients after surgery for solid cancer, using an Evidence Based Medicine (EBM) approach; B) to assess the possible discrepancies between the theoretical model and the clinical protocols currently used for the follow-up of treated patients; c) to compare the real costs of the radiological examinations performed in a group of cancer patients followed up after surgery and the theoretical costs that would have been incurred had the patients been followed up according to the theoretical (evidence-based) follow-up programme.


METHODS
We searched traditional and secondary databases for research papers and guidelines by international scientific societies published in the last 10 years and concerning the clinical impact of follow-up programs in patients operated on for colorectal and lung carcinoma. The papers were selected based on level of evidence using the systematic review approach of EBM. In each paper selected, we considered the overall survival and disease-free survival, quality of life, side and toxic effects of therapy, costs and psychological aspects to formulate a judgement on the usefulness of the radiological tests. Subsequently, the clinical and imaging follow-up of 40 patients who had undergone surgical resection for colorectal cancer (20 patients) and lung cancer (20 patients) between 1998 and 2004 were retrospectively reviewed, and the costs of the follow-up programs for the two groups were analysed and compared with those of the theoretical evidence-based programmes.


RESULTS
Of the 41 papers selected after systematic review only nine datasets were considered for our final analysis. The majority of papers (7 out of 9) and all the guidelines published by international Scientific Societies agreed on the poor value of closed imaging in the follow-up of patients who have undergone surgery for colorectal and lung cancer. A significant difference was found between the real costs of the follow-up programmes implemented in the 40 patients considered and the theoretical costs derived from the guideline recommendations (an excess of 99.06% for lung cancer, and 93.6% for colon cancer).


CONCLUSIONS
Our findings can serve as a basis to start a discussion within the scientific community about the role of radiological follow-up in cancer patients with the aim of defining a more rational use of resources.
Giovagnoni
Andrea
A
Istituto di Radiologia, Oncologia Clinica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I Torrette, Lancisi Ancona, Italy. a.giovagnoni@sirm.org
Ottaviani
Letizia
L
Mensà
Anna
A
Durastanti
Martina
M
Floriani
Irene
I
Cascinu
Stefano
S
D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography / Q000592:standards