title: Patients' and physicians' roles in detecting recurrent Hodgkin lymphoma following complete remission.
abstract: BACKGROUND
  Optimal post-treatment surveillance for patients with Hodgkin lymphoma in first complete remission (CR) is unknown. Guidelines are based on consensus rather than high-quality evidence. It is unknown if routine screening leads to earlier relapse detection or translates into better outcomes.
  
  
  METHODS
  We identified 258 patients with relapse after CR and determined whether the recurrence was detected as a result of patient-detected symptoms (PT group) or through exams or tests ordered by the physician in the absence of symptoms (MD group).
  
  
  RESULTS
  Of 258 recurrences, 182 (71%) were in the PT group. The median time to diagnosis of recurrence was similar in both groups (PT group = 1.65 years; MD group = 1.95 years; P = 0.69). Neither the postrelapse progression-free (PFS, P = 0.26) nor overall survival (OS, P = 0.40) differed significantly between the groups.
  
  
  CONCLUSIONS
  Patients are much more likely to detect recurrence than their physicians employing routine follow-up testing. There is no difference in PFS or OS between patients whose recurrence is self-diagnosed versus those whose recurrence is diagnosed by physician through routine screening. We found no benefit for detection of HL recurrence in asymptomatic patients and thus cannot support the routine use of costly, anxiety-provoking or potentially harmful tests in the absence of symptoms.
authors.affiliation: Department of Medical Oncology, British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada. alain.bestawros@umontreal.ca
authors.forename: A
authors.initials: A
authors.lastname: Bestawros
authors.forename: L
authors.initials: L
authors.lastname: Foltz
authors.forename: N
authors.initials: N
authors.lastname: Srour
authors.forename: K J
authors.initials: KJ
authors.lastname: Savage
authors.forename: J M
authors.initials: JM
authors.lastname: Connors
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D010819:Physician's Role; D012074:Remission Induction; D016353:Self-Examination