title: The value of routine follow-up after treatment for head and neck cancer. A national survey from DAHANCA.
abstract: BACKGROUND
  The post-treatment follow-up is well-integrated in the oncologic care tradition, based on the risk of developing recurrent disease or new primary tumors in treated patients. Furthermore, follow-up serves as an opportunity to monitor treatment effects and to provide clinical care of side effects. In this study we measured the activity and effectiveness of routine follow-up in head and neck cancer and assessed the value of follow-up from the perspectives of both physicians and the patients.
  
  
  METHODS
  During a period of six weeks a prospective national cross section cohort of 619 patients attending regular follow-up were enrolled. All patients had received intended curative treatment for head and neck cancer and all were followed according to DAHANCA guidelines. Data were collected by the physician filling in a registration form containing chosen key parameters and patients filling in a validated questionnaire.
  
  
  RESULTS
  The majority (91%) of the 619 visits was planned, and 75% of all visits included either tumor or treatment-related problems. Suspicion of recurrent disease led to further diagnostic work-up in 80 visits (13%). A total of 29 recurrences were found, and of these seven (25%) were asymptomatic, i.e. the "number needed to see" to detect one asymptomatic recurrence was 99. Treatment-related normal-tissue problems were addressed in 72% of all visits, and among these 18% required intervention. Although the majority of problems (either suspicion of recurrent disease or late effects) occurred within a few years after treatment, 39% of patients seen after three years also had problems. The majority of patients (97%) expressed satisfaction with the planned follow-up.
  
  
  CONCLUSIONS
  Only few relapses are found in asymptomatic patients at routine follow-up, with one silent recurrence detected per 99 visits. However, head and neck cancer survivors have a substantial need for management of sequelae. In this context, a centralized routine follow-up may still be worthwhile.
authors: Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark. anjapagh@oncology.dk
authors: Anja
authors: A
authors: Pagh
authors: Thomas
authors: T
authors: Vedtofte
authors: Charlotte Duch
authors: CD
authors: Lynggaard
authors: Niclas
authors: N
authors: Rubek
authors: Matilde
authors: M
authors: Lonka
authors: Jørgen
authors: J
authors: Johansen
authors: Elo
authors: E
authors: Andersen
authors: Claus Andrup
authors: CA
authors: Kristensen
authors: Christian
authors: C
authors: von Buchwald
authors: Maria
authors: M
authors: Andersen
authors: Christian
authors: C
authors: Godballe
authors: Jens
authors: J
authors: Overgaard
authors: Cai
authors: C
authors: Grau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000628:therapy*; D003266:Continuity of Patient Care; D003625:Data Collection; D016208:Databases, Factual / Q000706:statistics & numerical data; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011237:Predictive Value of Tests; D055815:Young Adult