Proposed follow up programme after curative resection for lower third oesophageal cancer

Abstract

The incidence of oesophageal adenocarcinoma has risen throughout the Western world over the last three decades. The prognosis remains poor as many patients are elderly and present with advanced disease. Those patients who are suitable for resection remain at high risk of disease recurrence. It is important that cancer patients take part in a follow up protocol to detect disease recurrence, offer psychological support, manage nutritional disorders and facilitate audit of surgical outcomes. Despite the recognition that regular postoperative follow up plays a key role in ongoing care of cancer patients, there is little consensus on the nature of the process. This paper reviews the published literature to determine the optimal timing and type of patient follow up for those after curative oesophageal resection.

Patients' experiences of supportive care from a long-term perspective after oesophageal cancer surgery – A focus group study

“…This lack of knowledge may lead to uncertainty about what the postoperative support should focus on and in which degree information and support should be given. According to Moyes et al (2010) the aim with a follow-up should be to provide support helping the patients deal with new symptoms as they arise and thereby enhancing their quality of life. In earlier studies, supportive care programmes for patients within other cancer settings has been stated to be able to enhance QOL (Howell et al, 2008;Rosenbaum et al, 2004) as well as to reduce unmet supportive care needs and improve continuity of care (Howell et al, 2008).…”

Follow-Up Practices of Surgeons and Medical Oncologists in Australia and New Zealand Following Resection of Esophagogastric Cancers

“…2) Length of follow-up in published guidelines and literature is poorly defined, but most support follow-up for at least 5 years. 2,3,5) The Australian guidelines recommend 3 monthly follow-up for 2 years and then 6 monthly clinical follow-up to 5 years, with scope for longer follow-up if clinically indicated. 7) Although clinical information in our survey did have some impact on views regarding imaging, none of the scenarios showed clear consensus on whether routine imaging was appropriate or not.…”

“…2,3,10) Depending on the type, stage, and treatment, at least 80% of recurrences have occurred by 21-38 months postoperatively. 2,5,10) In a 2010 review article, most centers supported an initial 4-to 6-week postoperative review, with follow-up 3 monthly in the first year, 6 monthly in the second year, and annually thereafter. 2) Length of follow-up in published guidelines and literature is poorly defined, but most support follow-up for at least 5 years.…”

“…2,5,10) In a 2010 review article, most centers supported an initial 4-to 6-week postoperative review, with follow-up 3 monthly in the first year, 6 monthly in the second year, and annually thereafter. 2) Length of follow-up in published guidelines and literature is poorly defined, but most support follow-up for at least 5 years. 2,3,5) The Australian guidelines recommend 3 monthly follow-up for 2 years and then 6 monthly clinical follow-up to 5 years, with scope for longer follow-up if clinically indicated.…”

“…[2][3][4] Thus, follow-up protocols tend to reflect institutional or individual preferences. 5) Several published guidelines have been developed around the world, including the Scottish Intercollegiate Guidelines Network (SIGN), the British Society of Gastroenterology 2011, the European Society of Medical Oncology, the National Comprehensive Cancer Network (NCCN) 2009 3,4,6) and in Australia, the "Optimal Care Pathway for People with Oesophagogastric Cancer" has recently been published and endorsed by Government Health Departments.…”