title: Outpatient follow-up appointments for patients having curative treatment for cancer of the head and neck: are the current arrangements in need of change?
abstract: Although there are recommendations, there is little evidence about the rationale for the frequency and duration of review appointments for patients with cancer of the head and neck. We have recorded the pattern of follow-up in a tertiary cancer centre and its association with survival and recurrent disease. We used clinical letters and a prospectively maintained database to obtain details on 297 patients who were treated curatively for squamous cell carcinoma (SCC) of the oral cavity between 2005 and 2008. Mean (SD) age was 63 (12) years and 58% (n = 171) were male. Most patients were seen about 6 times in year one, 3 times in year 2, twice in year 3, twice in year 4, once or twice in year 5, and once yearly beyond year 5. Fewer clinics were scheduled for and attended by patients over 75 years of age, those with overall clinical grades 0-1, and those treated by operation alone in contrast to those who also had adjuvant radiotherapy. Patients were usually seen about 15 times over the 5 years. Taking into account the stage of the tumour and overall mortality, the number and timing of follow-up visits is adequate for the needs of patients with stage II-IV disease. Those with stage I disease may be considered for discharge after the third year if they are told about the risk factors, and signs and symptoms of recurrent disease, and surveillance in primary care.
authors.affiliation: Leeds Teaching Hospitals and St James Institute of Oncology, Leeds General Infirmary, LS1 3EX. Electronic address: a.kanatas@doctors.org.uk.
authors.forename: A
authors.initials: A
authors.lastname: Kanatas
authors.affiliation: Christchurch orthodontics, 67 Stour Road, Christchurch, Dorset, BH23 1LN. Electronic address: mr.neeel@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Bala
authors.affiliation: Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk, L39 4QP. Electronic address: astraglobeltd@btconnect.com.
authors.forename: D
authors.initials: D
authors.lastname: Lowe
authors.affiliation: Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk, L39 4QP and Consultant, Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK. Electronic address: snrogers@doctors.org.uk.
authors.forename: S N
authors.initials: SN
authors.lastname: Rogers
mesh_terms: D000359:Aftercare; D000367:Age Factors; D000368:Aged; D001071:Appointments and Schedules; D002294:Carcinoma, Squamous Cell / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005887:Gingival Neoplasms / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009060:Mouth Floor / Q000473:pathology / Q000601:surgery; D009062:Mouth Neoplasms / Q000601:surgery / Q000628:therapy*; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D010045:Outpatients; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D014062:Tongue Neoplasms / Q000601:surgery / Q000628:therapy
keywords: Follow-up; Head and neck cancer; Oral cancer; Recurrence; Surveillance