Oncological surgery follow-up and quality of life: meta-analysis

Abstract

Background Previous trials found that more intensive postoperative surveillance schedules did not improve survival. Oncological follow-up also provides an opportunity to address psychological issues (for example anxiety, depression, and fear of recurrence). This systematic review assessed the impact of a less intensive surveillance strategy on health-related quality of life (HRQoL), emotional well-being, and patient satisfaction. Methods A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, Cochrane database, PsycINFO, and Google Scholar to identify studies comparing different follow-up strategies after oncological surgery and their effect on HRQoL and patient satisfaction, published before 4 May 2022. A meta-analysis was conducted on the most relevant European Organisation for Research and Treatment of Cancer QLQ-C30 and Hospital Anxiety and Depression Scale subscales. Results Thirty-five studies were identified, focusing on melanoma (4), colorectal (10), breast (7), prostate (4), upper gastrointestinal (4), gynaecological (3), lung (2), and head and neck (1) cancers. Twenty-two studies were considered to have a low risk of bias, of which 14 showed no significant difference in HRQoL between follow-up approaches. Five studies with a low risk of bias showed improved HRQoL or emotional well-being with a less intensive follow-up approach and three with an intensive approach. Meta-analysis of HRQoL outcomes revealed no negative effects for patients receiving less intensive follow-up. Conclusion Low-intensity follow-up does not diminish HRQoL, emotional well-being, or patient satisfaction.

Comment on ‘Oncological surgery follow-up and quality of life: meta-analysis’

“…The review valuably consolidates evidence suggesting less-intensive follow-up strategies after oncological surgery do not adversely impact health-related quality of life (HRQoL), emotional well-being or patient satisfaction 1 . However, some elements merit closer consideration.…”

Long-term outcome after surgical resection of non-high-risk gastrointestinal stromal tumours without adjuvant therapy

“…Its presence appears to be associated with reduced quality of life 21 . A recent study 22 evaluating health-related quality of life during oncological follow-up after surgery found that less intensive surveillance does not diminish emotional well-being or patient satisfaction. Taken together, the disadvantages of routine follow-up for detecting disease recurrence in patients with a non-high-risk GIST may outweigh the potential benefit.…”

Patient-led home-based follow-up after surgery for colorectal cancer: the protocol of the prospective, multicentre FUTURE-primary implementation study

“…In addition to the detection of disease recurrence, follow-up contributes to psychological support and surveillance of postoperative complaints. However, less intensive follow-up has no negative influence on health-related quality of life (HRQoL) 6. Besides the lacking survival and HRQoL benefit, there are other reasons to revisit current follow-up practice in patients with CRC.…”

“…However, less intensive follow-up has no negative influence on health-related quality of life (HRQoL). 6 Besides the lacking survival and HRQoL benefit, there are other reasons to revisit current follow-up practice in patients with CRC. Frequent hospital visits have significant impact on patients’ lives, as follow-up visitations evoke distress around the time of visits.…”