Evidence-Based Follow-up for Adults With Cancer

Abstract

Background: The objectives of follow-up care for cancer patients include psycho- social assistance and the detection of health problems. The concept of follow-up care rests on the assumption that the early detection of cancer recurrences and disease- or treatment-related complications is beneficial to patients. In this article, we provide an overview of the scientific evidence supporting current recommen- dations for the follow-up care of patients with colorectal cancer, lung cancer, and lymphoma.

Methods: This review is based on pertinent publications that were retrieved by a selective search in PubMed, supplemented by the authors' own experience in patient care and guideline creation.

Results: As recurrences usually arise soon after initial treatment, the recommended follow-up interval is shorter in the first two years (3-6 months) and longer thereafter (6-12 months). The question of which particular follow-up studies should be per- formed has only been systematically analyzed in a few cases. For patients with colorectal cancer, colonoscopy is the most important study. Intensive follow-up care is associated with a statistically non-significant increase in the survival rate compared to minimal follow-up care (77.5% versus 75.8%). Intensive diagnostic follow-up studies have been found to lead to a doubling of the frequency of operations for recurrence with curative intent, yet without any effect on the average survival time. The findings in lung cancer are similar. However, after tumor resection with curative intent, regularly repeated CT scanning leads to a survival advantage. In lymphoma patients, the longer the interval from primary treatment, the greater the likelihood of treatment-related secondary illnesses. It is not yet known how follow-up care should be provided to these patients in order to help them best.

Conclusion: The evidence supporting the efficacy of currently recommended modalities of follow-up care for cancer patients is weak. Until more data from clinical studies become available, the current guidelines should be followed.

Figure 1

The effect of screening method (conventional chest X-ray versus low-dose CT) on the cumulative number of detected cases of lung cancer (a) and lung cancer mortality (b) in high-risk patients investigated in a screening study (National Lung Screening Trial) (modified from [20]). Although the superiority of CT was demonstrated in a screening study under randomized conditions, it should apply in the same way to follow-up.

Figure 2

Cumulative development of second malignancies in curatively treated patients with non-Hodgkin’s lymphoma in relation to the number of computed tomography (CT) scans performed in the first year following diagnosis. (Modified from [33]; reprinted with kind permission from John Wiley and Sons)