FOLLOW-UP POLICY AFTER TREATMENT FOR HODGKINS-DISEASE - TOO MANY CLINIC VISITS AND ROUTINE TESTS - A REVIEW OF HOSPITAL RECORDS

Objective: To examine the effectiveness of routine clinic review in de tecting relapse after treatment for Hodgkin's disease. Design: Review of hospital records. Setting: Regional centre for cancer treatment and research. Subjects: 210 patients with Hodgkin's disease recruited to a chemotherapy trial protocol between 1984 and the end of 1990 who had achieved a complete or partial remission after treatment. Main outcom e measures: The number of clinic visits made by patients over the peri od of observation, the number of relapses occurring during that time, and the route by which relapse was detected. Results: The 210 patients generated 2512 outpatient reviews, and 37 relapses were detected. Thi rty relapses (81%) were diagnosed in patients who described symptoms, which in 15 cases had resulted in an earlier appointment being arrange d. In only four cases (11%; 95% confidence interval 4% to 25%) was rel apse detected as a result of routine physical examination or investiga tion of a patient who did not have symptoms. Conclusions: Relapse of H odgkin's disease after treatment is usually detected as a result of th e investigation of symptoms rather than by routine screening of asympt omatic patients. It is therefore proposed that the frequency of routin e follow up visits should be reduced and greater emphasis placed on pa tient education. This should underline the importance of symptoms and encourage patients to arrange an earlier appointment if these develop.