Who should follow up lung cancer patients after operation?

Background. It is unclear whether follow-up by a thoracic surgeon after lun g cancer resection alters survival. Methods. The charts of 245 early stage (less than or equal to IIB) nonsmall cell lung cancer patients, diagnosed between 1988 and 1995, were reviewed. Follow-up data were complete to January 1, 1997 in 96.3% (236 of 245) of c ases. Results. Ninety of the 111 recurrences were detected before discharge from the thoracic clinic. Despite clinic follow-up, 66.7% (60 of 90) were identi fied by the family physician, and only 28.9% (26 of 90) by the surgeon. The remaining 4.4% (4 of 90) were detected by other physicians. Ninety-six per cent (25 of 26) surgeon-detected recurrences had suspicious clinical or che st radiographic findings, compared with 92% for family physician-detected r ecurrences (55 of 60; not significant). The cost per recurrence detected by surgeons was Can $4,367. A. 75% cost savings could ensure if patients were followed up by their family physician. There was no 5-year survival benefi t for patients whose recurrence was detected by the surgeon. Conclusions. Long-term follow-up after limited-stage non-small cell lung ca ncer resection could possibly be performed by a family physician alone with out compromising overall survival, and with significant cost savings. (C) 2 000 by The Society of Thoracic Surgeons.