Does the Frequency of Routine Follow-Up after Curative Treatment for Head-and-Neck Cancer Affect Survival?

Hall, Stephen F.; Owen, Timothy; Griffiths, Rebecca; Brennan, Kelly

doi:10.3747/co.26.4949

Cited by 9 publications

(15 citation statements)

References 29 publications

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“…In Smith [12], the breast cancer surveillance guidelines are discussed. We observe that the Kaplan-Meier method is universal and can be applied not only to the study of breast cancer treatment but also to other cancers to compare the survival of different groups of patients after diagnosis, see for instance [13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Actuarial Analysis of Survival among Breast Cancer Patients in Lithuania

et al. 2021

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Breast cancer is the most common cause of mortality due to cancer for women both in Lithuania and worldwide. Chances of survival after diagnosis differ significantly depending on the stage of disease at the time of diagnosis. Extended term periods are required to estimate survival of, e.g., 15–20 years. Moreover, since mortality of the average population changes with time, estimates of survival of cancer patients derived after a long period of observation can become outdated and can be no longer used to estimate survival of patients who were diagnosed later. Therefore, it can be useful to construct analytic functions that describe survival probabilities. Shorter periods of observation can be enough for such construction. We used the data collected by the Lithuanian Cancer Registry for our analysis. We estimated the chances of survival for up to 5 years after patients were diagnosed with breast cancer in Lithuania. Then we found analytic survival functions which best fit the observed data. At the end of this paper, we provided some examples for applications and directions for further research. We used mainly the Kaplan–Meier method for our study.

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Section: Introductionmentioning

confidence: 99%

Actuarial Analysis of Survival among Breast Cancer Patients in Lithuania

et al. 2021

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“…Patients calling between appointments is established in follow-up and is utilised by around 8% of UK patients [ 12 ]. Clinicians perceived already known limitations with HNC follow-up, such as lack of flexibility to address the wide-ranging needs of HNC patients [ 6 , 9 ], expense [ 49 ] and lack of evidence [ [10] , [11] , [12] , [13] , 17 ] and seemed willing to change their provision. One UK HNC service is planning to change their follow-up to a patient-centred approach for low-risk patients [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…HNC patients have particularly diverse needs, due to extensive comorbidities and functional disruption [ 6 , 8 ], not accounted for by the ‘blanket approach’ to follow-up care [ 6 , 9 ]. Second, current follow-up regimens may not be the most effective or cost-effective at detecting cancer recurrence [ [10] , [11] , [12] , [13] ], nor provide a survival advantage [ 14 ]. Third, routine scheduled appointments are resource-intensive and potentially unsustainable given increasing HNC incidence [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Alternative follow-up paradigms, including those used in other cancers, therefore need to be considered and researched for HNC [ 10 , 12 , 16 , 17 ]. Systematic reviews suggest that patient-directed surveillance or patient-initiated follow-up (referred to here as PIFU) may have comparable clinical outcomes to and better patient satisfaction and cost-savings than regular follow-up, in a range of conditions [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinicians' Views of Patient-initiated Follow-up in Head and Neck Cancer: a Qualitative Study to Inform the PETNECK2 Trial

et al. 2022

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Aims: Current follow-up for head and neck cancer (HNC) is ineffective, expensive and fails to address patients' needs. The PETNECK2 trial will compare a new model of patient-initiated follow-up (PIFU) with routine scheduled follow-up. This article reports UK clinicians' views about HNC follow-up and PIFU, to inform the trial design. Materials and methods: Online focus groups with surgeons (ear, nose and throat/maxillofacial), oncologists, clinical nurse specialists and allied health professionals. Clinicians were recruited from professional bodies, mailing lists and personal contacts. Focus groups explored views on current follow-up and acceptability of the proposed PIFU intervention and randomised controlled trial design (presented by the study co-chief investigator), preferences, margins of equipoise, potential organisational barriers and thoughts about the content and format of PIFU. Data were interpreted using inductive thematic analysis. Results: Eight focus groups with 34 clinicians were conducted. Clinicians highlighted already known limitations with HNC follow-up e lack of flexibility to address the wide-ranging needs of HNC patients, expense and lack of evidence e and agreed that follow-up needs to change. They were enthusiastic about the PETNECK2 trial to develop and evaluate PIFU but had concerns that PIFU may not suit disengaged patients and may aggravate patient anxiety/fear of recurrence and delay detection of recurrence. Anticipated issues with implementation included ensuring a reliable route back to clinic and workload burden on nurses and allied health professionals. Conclusions: Clinicians supported the evaluation of PIFU but voiced concerns about barriers to help-seeking. An emphasis on patient engagement, psychosocial issues, symptom reporting and reliable, quick routes back to clinic will be important. Certain patient groups may be less suited to PIFU, which will be evaluated in the trial. Early, meaningful, ongoing engagement with clinical teams and managers around the trial rationale and recruitment process will be important to discourage selective recruitment and address risk-averse behaviour and potential workload burden.

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“…There is also evidence supporting survivorship models with follow‐up periods shorter than the currently recommended 5 years 18 . Most of these authors support personalized follow‐up regimens dependent on patient risk factors 3,16‐18 . Factors that are strongly associated with HNC recurrence and decreased survival are tobacco use after treatment, staging, and human papillomavirus status; therefore, these characteristics can be used to guide regimens 18,19 …”

Section: Discussionmentioning

confidence: 99%

Model of an Advanced Practice Provider–Led Head and Neck Cancer Survivorship Clinic: Evaluation of a 4‐Year Experience

Silva-Nash

Davis

Gardner

et al. 2022

Otolaryngol.--head neck surg.

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Objective To report the efficacy and safety of an advanced practice provider–led head and neck cancer survivorship clinic. Study Design Retrospective chart review. Setting Tertiary academic medical center. Methods Patients were enrolled into the survivorship clinic after undergoing 1-year follow-up with the primary head and neck surgeon. Those enrolled between December 2016 and October 2020 were retrospectively reviewed for diagnosis, staging, pattern of recurrence, visit frequency, and compliance. Surgical respectability of recurrent disease was used as a surrogate for timely diagnosis. Results An overall 570 patients were followed within the survivorship clinic. The mean length of follow-up was 13.6 months. Mucosal primaries represented 72.6% of patients. A majority of the primary malignancies were squamous cell carcinoma (77.7%). The most common primary subsites were the oropharynx (26.7%), oral cavity (25.1%), cutaneous (17.0%), and larynx (15.3%). Recurrence was detected in 50 patients (8.8%): 26 local, 12 regional, and 14 distant. Two patients had multiple synchronous recurrences. Twelve (2.1%) second primary cancers were detected. Of the 36 cases of locoregional recurrence, 32 (88.9%) were deemed amenable to salvage surgical intervention, with or without adjuvant therapy. Negative margins were obtained in 21 of the 23 (91.3%) local recurrences that underwent salvage resection. Conclusion Advanced practice provider–based surveillance of head and neck cancer, without risk stratification, appears to be a sound model but needs further prospective evaluation. Consistent with literature, 88.9% of patients with locoregional recurrence were candidates for curative-intent salvage surgery, emphasizing that recurrences are identified in a timely fashion.

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Does the Frequency of Routine Follow-Up after Curative Treatment for Head-and-Neck Cancer Affect Survival?

Cited by 9 publications

References 29 publications

Actuarial Analysis of Survival among Breast Cancer Patients in Lithuania

Actuarial Analysis of Survival among Breast Cancer Patients in Lithuania

Clinicians' Views of Patient-initiated Follow-up in Head and Neck Cancer: a Qualitative Study to Inform the PETNECK2 Trial

Model of an Advanced Practice Provider–Led Head and Neck Cancer Survivorship Clinic: Evaluation of a 4‐Year Experience

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