Effect of routine follow-up after treatment for laryngeal cancer on life expectancy and mortality: results of a Markov model analysis.
BACKGROUND
Routine follow-up is offered to all patients with laryngeal cancer who are treated with curative intent. Although time and resources are devoted to surveillance, the effect of asymptomatic recurrence detection is not well understood. For this study, the authors evaluated the effect that routine follow-up may have on life expectancy and disease-specific mortality rate for patients with laryngeal cancer.


METHODS
Using a Markov model, a cohort simulation was performed on 4 hypothetical age groups of patients with laryngeal cancer. Three different follow-up strategies were compared-the current schedule, no follow-up, and the perfect follow-up-in which all recurrences were detected asymptomatically. Sensitivity analyses were performed to study the impact of variations in the transition rates on life expectancy.


RESULTS
Compared with no follow-up, the current schedule showed a gain in life expectancy with a range from 0.3 years to 1.5 years that decreased with advancing age. Abolishing the current follow-up schedule raised the disease-specific mortality rate; the increase ranged from 2.8% to 5.9%. Variations of +/-25% in the transition rates produced only a modest effect on life expectancy.


CONCLUSIONS
A small reduction in life expectancy was observed when follow-up was withheld from the majority of patients. Disease-specific mortality rates rose when no follow-up was provided. These rates probably were overestimated. A simplified version of the current follow-up protocol may be implemented.
Ritoe
Savitri C
SC
Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. s.ritoe@kno.umcn.nl
de Vegt
Femmie
F
Scheike
Inger M
IM
Krabbe
Paul F M
PF
Kaanders
Johannes H A M
JH
van den Hoogen
Frank J A
FJ
Verbeek
André L M
AL
Marres
Henri A M
HA
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000628:therapy; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008954:Models, Biological; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors