POSTTREATMENT MANAGEMENT OPTIONS FOR PATIENTS WITH LUNG-CANCER

Objectives The first objective was to identify variations in patient m anagement practice patterns after potentially curative lung cancer sur gery. Patient management practice patterns were expected to range from intensive follow-up to no active surveillance.The second objective wa s to measure whether intensity of follow-up was related to patient out comes. Methods An 18-month retrospective analysis was conducted of 182 patients with low TNM stage (less than or equal to IIIA) lung cancer who were surgically treated with curative intent over the 11-year peri od from 1982 through 1992 at the St. Louis Department of Veterans Affa irs Medical Center. Results Patients were followed for a mean of 3.3 y ears, until death or the end of the study. Analyses of diagnostic test and outpatient visit frequency distributions and cluster analyses fac ilitated the identification of 62 nonintensively followed patients and 120 intensively followed patients. Both groups were comparable at bas eline, and there were no significant differences in patient outcomes a ttributable to intensity of follow-up. Intensively followed patients d id, however, live an average of 192 days longer than nonintensively fo llowed patients. Conclusions Significant variations in follow-up pract ice patterns can exist within a single health care facility. In this a nalysis, variations in test and visit frequency did not result in stat istically significant differences in patient outcomes, though the surv ival difference between groups suggests that some benefit might exist. Only well-designed prospective trials are likely to answer the questi on of what constitutes optimal follow-up after potentially curative lu ng cancer treatment.