Is follow-up of lung cancer patients after resection medically indicated and cost-effective?

Garrett L. Walsh, Maeve O'Connor, Kelly M. Willis, Mira Milas, Rose S. Wong, Jonathan C. Nesbitt, Joe B. Putnam, J. Jack Lee, Jack A. Roth

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    161 Scopus citations

    Abstract

    Background.: There are no guidelines for the appropriate follow-up of patients after pulmonary resection for lung cancer. Methods.: Three-hundred fifty-eight consecutive patients who had undergone complete resections of non-small cell lung cancer between 1987 and 1991 were evaluated for tumor recurrence and development of second primary tumors. Recurrences were categorized by site (local or distant), mode of presentation (symptomatic or asymptomatic), treatment given (curative intent or palliative), and duration of overall survival. Results.: Recurrences developed in 135 patients (local only, 32; local and distant, 13; and distant only, 90). Of these, 102 were symptomatic and 33 were asymptomatic (most diagnosed by screening chest roentgenogram). Forty patients received treatment with curative intent (operation or radiation therapy > 50 Gy) and 95 were treated palliatively. The median survival duration from time of recurrence was 8.0 months for symptomatic patients and 16.6 months for asymptomatic patients (p = 0.008). Multivariate analysis shows that disease-free interval (greater than 12 months or less than or equal to 12 months) was the most important variable in predicting survival after recurrence and that mode of presentation, site of recurrence, initial stage, and histologic type did not significantly affect survival. New primary tumors developed in 35 patients. Conclusions.: Although detection of asymptomatic recurrences gives a lead time bias of 8 to 10 months, mode of treatment and overall survival duration are not greatly affected by this earlier detection. Disease-free interval appears to be the most important determinant of survival. Screening for asymptomatic recurrences in patients who have had lung cancer is unlikely to be cost-effective. Frequent follow-up and extensive radiologic evaluation of patients after operation for lung cancer are probably unnecessary.

    Original languageEnglish (US)
    Pages (from-to)1563-1572
    Number of pages10
    JournalThe Annals of thoracic surgery
    Volume60
    Issue number6
    DOIs
    StatePublished - Dec 1995

    ASJC Scopus subject areas

    • Surgery
    • Pulmonary and Respiratory Medicine
    • Cardiology and Cardiovascular Medicine

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    Walsh, G. L., O'Connor, M., Willis, K. M., Milas, M., Wong, R. S., Nesbitt, J. C., Putnam, J. B., Lee, J. J., & Roth, J. A. (1995). Is follow-up of lung cancer patients after resection medically indicated and cost-effective? The Annals of thoracic surgery, 60(6), 1563-1572. https://doi.org/10.1016/0003-4975(95)00893-4