‘When will I see you again?’ Using local recurrence data to develop a regimen for routine surveillance in post‐treatment head and neck cancer patients

Lester, Shane; Wight, Richard G.

doi:10.1111/j.1749-4486.2009.02033.x

Cited by 46 publications

(43 citation statements)

References 10 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This seems to support their claim that in general, routine follow-up regimes are rarely indicated after the third year. However, four patients were suspected of recurrence of laryngeal cancer at 220 months; therefore, seemingly supporting claims by Lester et al and Spector et al [5,15] that laryngeal primaries should be followed up for 7 years. Marchant et al [16] suggest that follow-up for life should be considered if detrimental habits such as smoking and alcohol use persist.…”

Section: Discussionmentioning

confidence: 85%

“…Their input ensures a more holistic patient approach, and many rehabilitative issues traditionally discussed with the surgeon are more efficiently addressed through their own individual systems. The guidelines outlined in Table 1 differ in their advice as there is currently no high-level evidence to support any one given regime, and many variations exist from region to region [5,13]. The authors believe that a streamlining of the current system to a more modern, efficient one that takes into account geographical variations and individual patient requirements is needed.…”

Section: Discussionmentioning

confidence: 93%

“…They recommend a focus on patient education in recognition of the signs and symptoms or recurrence. Conversely, in a more recent study, Lester et al [5] concluded that based on the local prospective data of 676 patients and published evidence, laryngeal primaries should be followed up for 7 years, whilst oropharyngeal and hypopharyngeal primaries should be followed up for 3 years. They also felt that relying on good patient education for the detection of recurrence through self-presentation was an unacceptable practice, as it would lead to the detection of less than two-thirds of recurrences [5].…”

Section: Introductionmentioning

confidence: 93%

“…The optimal follow-up regime for cancer patients has been a long-standing question [1][2][3].The premise that a routine follow-up regime facilitates the early detection and treatment of cancer recurrence has been investigated in large case series in several cancer fields [1,[4][5][6][7][8]. These studies vary in their view of whether regular, routine, long-term follow-up regimes are of limited benefit or not in terms of increased patient survival.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The follow-up of patients with head and neck cancer: an analysis of 1,039 patients

Kothari

Trinidade

Hewitt

et al. 2010

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

In all cancer specialities, there has been much debate about the best follow-up regime. The provision of a service that meets high standards whilst being cost-effective is increasingly pertinent. The objectives of the study were to examine: whether routine follow-up facilitates early diagnosis and recurrence; whether there is a cohort of patients who require a more intensive follow-up regime; whether follow-up should be customised to individual patients. A total of 1,039 consecutive outpatient consultations were prospectively analysed in a multicentre study. All adult patients who had undergone multidisciplinary, multimodality management for head and neck cancer were included. The case mix was representative of all head and neck tumour sites and stages. Suspicion of recurrence was noted in 10% (n = 96/951) of patients seen routinely. This rose to 68% (n = 60/88) for the subset of patients who had requested an appointment. Most recurrences were found within the first follow-up year (n = 64/156, 54%). Only 0.3% (n = 3/1,039) of asymptomatic patients attending routine appointments were suspected of having a recurrence, and two (0.2%) were found to have an actual recurrence following investigation. Of the total number of patients reporting a new suspicious symptom, recurrence was suspected in 56% (n = 152/270). Patients thus had a 98.1% sensitivity to raising suspicion for a recurrence based on the reporting of new symptoms with a 99.6% negative predictive value. Our data show that the efficiency of the current follow-up regime at detecting suspected recurrence of head and neck cancer is low, suggesting the need for a customised, more focused follow-up regime, tailored to individual cases. Patient education and close relationships with clinicians and allied health-care professionals are essential for early diagnosis and management of cancer recurrence. Follow-up regimes within the first year should be most intensive as recurrence is most likely within this time, and it serves to alleviate patient anxiety in the early post-treatment period. More research needs to be carried out to investigate the role of patient self-reporting and surveillance of cancer recurrence.

show abstract

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The follow-up of patients with head and neck cancer: an analysis of 1,039 patients

Kothari

Trinidade

Hewitt

et al. 2010

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…Most relapses of head-and-neck cancer occur during the first 3 years, with 80% occurring within 2 years of treatment completion and 95% within 3 years 41 , which supports the observed declining intensity trend. In a U.K. study 37 , data collected locally during a 10-year follow-up period were used to study time to first recurrence and to a new primary. The authors found that, of first cancer events, 95% occurred within the first 3 years for oropharyngeal and hypopharyngeal cancers and within 4.7 years for laryngeal cancer.…”

Section: Discussionmentioning

confidence: 99%

Variation in Routine Follow-Up Care After Curative Treatment for Head-and-Neck Cancer: A Population-Based Study in Ontario

et al. 2018

View full text Add to dashboard Cite

show abstract

Impact of provider type and number of providers on surveillance testing among survivors of head and neck cancers

Yao

Tam

et al. 2021

Cancer

View full text Add to dashboard Cite

BACKGROUND: Guidelines for follow-up after head and neck cancer (HNC) treatment recommend frequent clinical examinations and surveillance testing. Here, the authors describe real-world follow-up care for HNC survivors and variations in surveillance testing. METHODS: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, this study examined a population-based cohort of HNC survivors between 2001 and 2011 Usage of cross-sectional head and neck imaging (CHNI), chest imaging (CI), positron emission tomography (PET), fiberoptic nasopharyngolaryngoscopy (FNPL), and, in irradiated patients, thyroid function testing (TFT) was captured over 2 consecutive surveillance years. Multivariate modeling with logistic regression analyses was used to assess variations by clinical factors, nonclinical factors, number and types of providers seen and their evolution over time. RESULTS: Among 13,836 HNC survivors, the majority saw a medical, radiation, or surgical oncologist and a primary care provider (PCP; 81.7%) in their first year of surveillance. However, only 58.1% underwent either PET or CHNI, 47.8% underwent CHNI, 64.1% underwent CI, 32.5% underwent PET scans, 55.0% underwent FNPL, and 55.9% underwent TFT. In multivariate analyses, patients who followed up with more providers and those who followed up with both a PCP and an oncologist were more likely to undergo surveillance testing (P < .007). However, adjusting for providers seen did not explain the variations in surveillance testing rates based on age, race, education, income level, and place of residence. Over time, there was a gradual increase in the use of PET scans and TFT during surveillance years. CONCLUSIONS: In this large SEER-Medicare data study, only half of HNC survivors received the recommended testing, and greater compliance was seen in those who followed up with both an oncologist and a PCP. More attention is needed to minimize variations in surveillance testing across sociodemographic groups.

show abstract

‘When will I see you again?’ Using local recurrence data to develop a regimen for routine surveillance in post‐treatment head and neck cancer patients

Cited by 46 publications

References 10 publications

The follow-up of patients with head and neck cancer: an analysis of 1,039 patients

The follow-up of patients with head and neck cancer: an analysis of 1,039 patients

Variation in Routine Follow-Up Care After Curative Treatment for Head-and-Neck Cancer: A Population-Based Study in Ontario

Impact of provider type and number of providers on surveillance testing among survivors of head and neck cancers

Contact Info

Product

Resources

About