Practice patterns and clinical guidelines for posttreatment follow-up of head and neck cancers - A comparison of 2 professional societies

Objectives: To determine and compare the current follow-up practice pattern s of members of 2 professional societies of head and neck surgeons, and to compare these with the societies' published clinical practice guidelines. Design: A survey was mailed to the 640 members of the American Society for Head and Neck Surgery (ASHNS); results were compared with those of a simila r survey of the 824 members of the Society of Head and Neck Surgery (SHNS) and with the clinical practice guidelines of the consensus committee of bot h societies. Main Outcome Measures: Data were collected regarding the frequency of follo w-up visits after potentially curative resection of head and neck epidermoi d carcinoma and the types of diagnostic studies performed at each visit. Results: A. total of 318 ASHNS members responded to 1 of the mailings (49.7 %), of which 280 responses (43.8%) were evaluable. Most surgeons relied on directed history, physical examination, and routine chest radiograph at var ying intervals for detection of recurrences and second primary tumors. Othe r tests were used sporadically. For frequency of follow-up testing, the per centage of surgeons who followed the published guidelines varied from 97% i n postoperative year 1 to 62% in postoperative year 5. A mean of 24% of sur geons varied from the guidelines in their use of chest radiographs, and 45% varied in their use of liver function tests. The ASHNS members used signif icantly more office visits than the SHNS members during the first 2 postope rative years. Conclusions: The strategies used by members of the ASHNS and the SHNS for p osttreatment surveillance after potentially curative resection of malignant neoplasms of the head and neck were generally similar but showed some impo rtant differences. Most surgeons used directed history and physical examina tion at regular intervals, and annual chest radiographs. The follow-up prac tices of most members of these societies, which have recently merged, fall within the recommendations of the Clinical Guidelines Task Force.