Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
Acta Oncol. 2013 Feb;52(2):277-84. doi: 10.3109/0284186X.2012.741324.
The post-treatment follow-up is well-integrated in the oncologic care tradition, based on the risk of developing recurrent disease or new primary tumors in treated patients. Furthermore, follow-up serves as an opportunity to monitor treatment effects and to provide clinical care of side effects. In this study we measured the activity and effectiveness of routine follow-up in head and neck cancer and assessed the value of follow-up from the perspectives of both physicians and the patients.
During a period of six weeks a prospective national cross section cohort of 619 patients attending regular follow-up were enrolled. All patients had received intended curative treatment for head and neck cancer and all were followed according to DAHANCA guidelines. Data were collected by the physician filling in a registration form containing chosen key parameters and patients filling in a validated questionnaire.
The majority (91%) of the 619 visits was planned, and 75% of all visits included either tumor or treatment-related problems. Suspicion of recurrent disease led to further diagnostic work-up in 80 visits (13%). A total of 29 recurrences were found, and of these seven (25%) were asymptomatic, i.e. the "number needed to see" to detect one asymptomatic recurrence was 99. Treatment-related normal-tissue problems were addressed in 72% of all visits, and among these 18% required intervention. Although the majority of problems (either suspicion of recurrent disease or late effects) occurred within a few years after treatment, 39% of patients seen after three years also had problems. The majority of patients (97%) expressed satisfaction with the planned follow-up.
Only few relapses are found in asymptomatic patients at routine follow-up, with one silent recurrence detected per 99 visits. However, head and neck cancer survivors have a substantial need for management of sequelae. In this context, a centralized routine follow-up may still be worthwhile.
基于治疗患者中复发疾病或新原发性肿瘤的风险，治疗后随访已很好地融入肿瘤学治疗传统中。此外，随访也是监测治疗效果和提供副作用临床护理的机会。在这项研究中，我们测量了头颈部癌症常规随访的活动和效果，并从医生和患者的角度评估了随访的价值。
在六周的时间内，我们纳入了 619 名定期接受随访的头颈部癌症患者进行前瞻性全国横断面研究。所有患者均接受了头颈部癌症的治愈性治疗，且均根据 DAHANCA 指南进行随访。数据由医生填写包含选定关键参数的登记表格和患者填写经验证的问卷收集。
619 次就诊中，大多数（91%）是计划性的，75%的就诊均涉及肿瘤或治疗相关问题。80 次就诊（13%）因怀疑复发而进行了进一步的诊断性检查。共发现 29 例复发，其中 7 例（25%）无症状，即发现 1 例无症状复发所需的就诊次数为 99 次。所有就诊中，72%涉及治疗相关正常组织问题，其中 18%需要干预。尽管大多数问题（怀疑复发或晚期效应）发生在治疗后几年内，但 3 年后就诊的患者中仍有 39%存在问题。大多数患者（97%）对计划的随访表示满意。
在常规随访中，无症状患者中仅发现少数复发，每次常规随访可发现 1 例无症状复发。然而，头颈部癌症幸存者需要对后遗症进行管理。在这种情况下，集中常规随访可能仍然是有价值的。
