title: Detecting lung cancer relapse using self-evaluation forms weekly filled at home: the sentinel follow-up.
abstract: OBJECTIVE
  We aimed to assess if patients' ratings of symptoms can be used to provide an early indication of disease recurrence or progression in lung cancer. We proposed a simple self-evaluation form made of six clinical parameters weekly scored by patients at home as a follow-up--here named sentinel--to improve relapse detection. Its performances were compared to those of a routine imaging follow-up.
  
  
  METHODS
  Patients with lung cancer were prospectively recruited to weekly fill a form at home for self-assessing weight, fatigue, pain, appetite, cough, and breathlessness during at least 4 months. Each patient reported weight and assessed the severity of each symptom by grading it from 0 (no symptom) to 3 (major symptom). A score was retrospectively designed for discriminating patients with relapse from those without. Accuracy of relapse detection was then compared to values of the routine planned imaging.
  
  
  RESULTS
  Forty-three patients were included in our center and recruited for 16 weeks or more follow-up during which at least one tumor imaging assessment was performed (CT scan or PET-CT). Forty-one completed the form weekly. Sensitivity, specificity, and positive and negative predictive values of sentinel were high (86, 93, 86 % and 93 vs 79, 96, 92, and 90 % for routine imaging--p = ns) and well correlated with relapse (pχ2 > 0.001). Moreover, relapses were detectable with sentinel on average 6 weeks earlier than the planned imaging.
  
  
  CONCLUSIONS
  This study suggests that a personalized cancer follow-up based on a weekly self-evaluation of six symptoms is feasible and may be accurate for earlier detection of lung cancer relapse, allowing integration in electronic devices for real-time patient outcome follow-up.
authors.affiliation: Jean Bernard Center/Victor Hugo Clinic, 9 rue Beauverger, Le Mans, France, f.denis@cjb72.org.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Denis
authors.forename: Louise
authors.initials: L
authors.lastname: Viger
authors.forename: Alexandre
authors.initials: A
authors.lastname: Charron
authors.forename: Eric
authors.initials: E
authors.lastname: Voog
authors.forename: Christophe
authors.initials: C
authors.lastname: Letellier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059026:Diagnostic Self Evaluation; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography; D057285:Precision Medicine; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed