Follow-up in lung cancer - How often and for what purpose?

Objectives: The present study evaluates the cost-effectiveness of two follo w-up routines: a strict follow-up with frequent visits, imaging, and labora tory examinations was compared to a follow-up with infrequent visits that w ere scheduled mainly on the basis of the patient's symptoms. Methods: A retrospective evaluation was undertaken of 130 patients who unde rwent a complete resection of non-small cell lung cancer (NSCLC). All patie nts had complete follow-up for at least 2 years after their operation. The patients wee separated into two groups: Strict (n=67), with a routine follo w-up policy; and symptom (n=63), seen on a symptom-oriented basis. The cost s of the follow-up routines and the yield of each schedule were compared be tween the two groups. Results: There were no significant differences in the disease-free interval until the first detection of recurrence. In most patients, metastatic dise ases were diagnosed on the basis of symptoms, rather than by routine tests. The patients who had recurrent cancer diagnosed after surgery had a dismal survival rate irrespective of the follow-up schedule. The majority of pati ents with recurrence died of malignancy within a 2-year period. The costs o f strict vs symptom follow-up were significantly different, because of the greater number of routine imaging procedures performed in patients having s trict follow-up. On the other hand, when we analyzed only the frequency of hospitalization and the cost per da of hospital treatment for medical probl ems other than cancer recurrence, the patients in the strict group had a le ss expensive follow-up than the patients in the symptom group. Conclusions: The present study showed that a more cost-effective routine fo llow-up scheme should be advised for patients with completely resected NSCL C, without affecting overall outcome. Routine imaging follow-up is of quest ionable value, and it maya be indicated only in academic settings.