IS FOLLOW-UP OF LUNG-CANCER PATIENTS AFTER RESECTION MEDICALLY INDICATED AND COST-EFFECTIVE

Background. There are no guidelines for the appropriate follow-up of p atients after pulmonary resection for lung cancer. Methods. Three-hund red fifty-eight consecutive patients who had undergone complete resect ions of nonsmall cell lung cancer between 1987 and 1991 were evaluated for tumor recurrence and development of second primary tumors. Recurr ences were categorized by site (local or distant), mode of presentatio n (symptomatic or asymptomatic), treatment given (curative intent or p alliative), and duration of overall survival. Results. Recurrences dev eloped in 135 patients (local only, 32; local and distant, 13; and dis tant only, 90). Of these, 102 were symptomatic and 33 were asymptomati c (most diagnosed by screening chest roentgenogram). Forty patients re ceived treatment with curative intent (operation or radiation therapy > 50 Gy) and 95 were treated palliatively. The median survival duratio n from time of recurrence was 8.0 months for symptomatic patients and 16.6 months for asymptomatic patients (p = 0.008). Multivariate analys is shows that disease-free interval (greater than 12 months or less th an or equal to 12 months) was the most important variable in predictin g survival after recurrence and that mode of presentation, site of rec urrence, initial stage, and histologic type did not significantly affe ct survival. New primary tumors developed in 35 patients. Conclusions. Although detection of asymptomatic recurrences gives a lead time bias of 8 to 10 months, mode of treatment and overall survival duration ar e not greatly affected by this earlier detection. Disease-free interva l appears to be the most important determinant of survival. Screening for asymptomatic recurrences in patients who have had lung cancer is u nlikely to be cast-effective. Frequent follow-up and extensive radiolo gic evaluation of patients after operation for lung cancer are probabl y unnecessary.