Impact of surveillance among patients with resected pancreatic cancer following adjuvant chemotherapy

Wong, Selina K.; Gondara, Lovedeep; Renouf, Daniel J.; Lim, Howard John; Loree, Jonathan M.; Gill, Sharlene

doi:10.21037/jgo-20-422

Cited by 2 publications

(1 citation statement)

References 46 publications

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“…53 In British Columbia, Canada, up to 80% of patients with resected pancreatic cancer undergo routine surveillance imaging. 54…”

Section: Pancreatic Cancermentioning

confidence: 99%

Surveillance Imaging After Curative-Intent Treatment for Cancer: Benefits, Harms, and Evidence

Wilson,

Wright,

Koven

et al. 2024

JCO

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Every year, millions of patients globally are diagnosed with early-stage cancer and treated with curative intent. After treatment, patients are clinically followed for treatment toxicity and may undergo surveillance imaging to monitor for disease recurrence. The goal of post-treatment surveillance should be to improve patient overall survival (OS) and/or quality of life (QOL). Although there is value in monitoring for short-and longer-term treatment toxicity, a frequently stated goal is to identify early recurrence allowing early treatment to improve outcomes. However, for most tumors, there is no evidence to suggest that early diagnosis and treatment of recurrent asymptomatic disease improves OS or QOL. Moreover, surveillance scans may provoke anxiety and exacerbate fear of recurrence, 1-3 expose patients to further investigations for incidental findings, and cause under-recognized time toxicities and financial opportunity costs for patients and health systems.For patients who do undergo routine imaging surveillance (most often with computed tomography [CT]), there are three potential outcomes: (1) the CT scan is clear, providing shortterm reassurance; (2) the CT shows recurrence leading to complex discussions regarding early treatment versus observation in the absence of symptoms; and (3) there is an incidental finding leading to additional imaging and investigations (Table 1). Edelman et al 4 have proposed principles for evaluating follow-up investigations after curative-intent therapy: (1) the screening interval and duration of testing should be consistent with the maximal risk of recurrence and natural history of the tumor; (2) risk of second malignancies should guide tests;(3) tests should have high positive and negative predictive values; (4) therapy should be available that will result in cure, significant prolongation of life, or palliation of symptoms; and (5) initiation of earlier therapy should improve outcome. Unfortunately, for most tumor types, surveillance imaging after curative intent resection does not fulfill criteria 4 and 5.We are concerned that the risk-benefit ratio of routine surveillance imaging is not adequately considered by many practice guidelines, nor is it routinely discussed with patients. In this commentary, we review surveillance imaging recommendations after curative-intent treatment from international, regional, and country-specific guidelines (including ASCO, European Society of Medical Oncology [ESMO], National Comprehensive Cancer Network [NCCN], Cancer Care Ontario [CCO], and National Cancer Grid of India [NCGI]). We start with breast and colon cancer where recommendations are based on some evidence. We contrast this with other common solid tumors-pancreatic, lung, and gastric cancers-where there is limited supporting randomized evidence. Although previous papers have discussed surveillance imaging guidelines for individual cancers, [5][6][7][8][9] there is value to cross-tumor comparisons to understand variations in practice across our discipline and to learn from alternat...

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“…53 In British Columbia, Canada, up to 80% of patients with resected pancreatic cancer undergo routine surveillance imaging. 54…”

Section: Pancreatic Cancermentioning

confidence: 99%

Surveillance Imaging After Curative-Intent Treatment for Cancer: Benefits, Harms, and Evidence

Wilson,

Wright,

Koven

et al. 2024

JCO

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Detection, Patterns, and Outcomes of Recurrent HPV-Positive Oropharyngeal Squamous Cell Carcinoma

Shah,

Wilkins,

Safranek

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceRecurrent human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) is a relatively rare but serious disease with little empirical data. Previous works have studied patterns of recurrence in HPV-positive OPSCC, but only one has studied truly recurrent disease as opposed to persistent disease, and no work systematically analyzed posttreatment surveillance imaging strategies and how recurrences were detected.ObjectiveTo refine the understanding of HPV-positive OPSCC recurrence and inform optimal imaging surveillance strategies.Design, Setting, and ParticipantsThis retrospective cohort study involved electronic medical record review at a tertiary care hospital. Patients treated for OPSCC from 2012 to 2019 were extracted, and patients diagnosed with HPV-positive OPSCC were identified. Data were analyzed from December 2022 to May 2023.Main Outcome MeasuresPercentage of patients with a true recurrence, location of recurrence, time of recurrence detection, and method of recurrence detection. Recurrence was demonstrated with a scan after an imaging-established disease-free state 3 to 6 months posttreatment.ResultsOf the 367 patients with HPV-positive OPSCC (mean [SD] age, 60.6 [9.2] years; 310 [84.5%] male), 37 (10.1%) experienced true disease recurrence. Median (IQR) follow-up time of the cohort was 3.6 years (8.5-88 months), defined as time from diagnosis to death or last contact. Within the true recurrence cohort, 21 patients (56.8%) experienced local, regional, or local and regional recurrence (LRR); 15 (40.5%) experienced distant metastasis (DM); and 1 (2.7%) experienced both LRR and DM. The mean (SD) time for detecting LRR was 2.46 (1.94) years and was considerably longer compared to the 1.89 (0.87) years for detecting DM (difference, 0.57 [95% CI, −0.29 to 1.02] years). The majority of patients identified their recurrence through symptom changes (31 [81.1%]) rather than through surveillance imaging (3 [8.1%]).Conclusion and RelevanceIn this cohort study, 10.1% of patients experienced true HPV-positive OPSCC disease recurrence, with most incidences of DM occurring in the lung and brain. Disease recurrence was identified primarily through symptomatic change, suggesting that further research may be needed to understand the optimal surveillance strategies after definitive treatment.

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Impact of surveillance among patients with resected pancreatic cancer following adjuvant chemotherapy

Cited by 2 publications

References 46 publications

Surveillance Imaging After Curative-Intent Treatment for Cancer: Benefits, Harms, and Evidence

Surveillance Imaging After Curative-Intent Treatment for Cancer: Benefits, Harms, and Evidence

Detection, Patterns, and Outcomes of Recurrent HPV-Positive Oropharyngeal Squamous Cell Carcinoma

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