- Email: [email protected]
Consensus: the follow-up of the treated patient
Lung Cancer (2003) 42, S17 /S19
www.elsevier.com/locate/lungcan
Consensus: the follow-up of the treated patient M. Saundersa,*, J.P. Sculierb, D. Ballc, M. Capellod, K. Furusee, P. Goldstrawf, A.P. Meertb, V. Ninaneg, Y. Oheh, M. Paesmansi, K. Parkj, R. Pirkerk, P. Postmusl, Y. Sokolowd a
Department of Radiotherapy, Mount Vernon Hospital, Rickmansworth Rd., Northwood, Middlesex, UK Department of Medical Oncology, Institut Jules Bordet, Bruxelles, Belgium c Department of Radiation Oncology, Peter Mc Callum Cancer Institute, Melbourne, Australia d Department of Thoracic Surgery, Hoˆpital Erasme, Bruxelles, Belgium e Department of Respiratory Diseases, Osaka Central Hospital, Osaka, Japan f Department of Thoracic Surgery, Brompton Hospital, London, UK g Department of Pulmonary Diseases, Hoˆpital St-Pierre, Bruxelles, Belgium h Department of Medical Oncology, National Cancer Centre, Tokyo, Japan i Department of Statistics, Institut Jules Bordet, Bruxelles, Belgium j Department of Haematology/Oncology, Samsung Medical Centre, Seoul, South Korea k Department of Oncology, Clinic for Internal Medicine I, Vienna, Austria l Department of Pulmonary Diseases, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands b
Summary This is the first consensus document on the follow-up of the treated patient with non-small cell lung cancer that has been written by this group. The document has been drawn up by doctors coming from many different cultures and philosophical backgrounds. It acknowledges that there are published guidelines on the follow-up particularly those in trials, and does not wish to contradict these. There is lack of evidence-based medicine to recommend a strong general policy in this area. For those patients who were treated with curative intent the initial follow-up will depend upon the toxicity that is evident from the treatment given. Thereafter the interval between follow-up visits should be every 3 months for the first two years, then every 6 months for up to five years. Rapid and easy access to the multidisciplinary team should be available. Full examination and chest X-ray should be carried out on each visit but other investigations should be determined by clinical need. For those patients treated with palliative intent the interval between follow-up visits once the acute reactions have settled will depend upon the adequacy of the control of the symptom and the availability of separate palliative care teams. At all times the patient should have rapid access to the multidisciplinary team and in general frequent follow-up, that is at intervals of one to two months, may be appropriate during the first six months. Follow-up constitutes an important part of lung cancer management. Efforts should be made to gain clinical material to give us evidence-based guidelines. – 2003 Elsevier Ireland Ltd. All rights reserved.
*Corresponding author. Tel.: /44-1923-844-5433; fax: /44-1923-844-167. E-mail address: [email protected] (M. Saunders). 0169-5002/03/$ - see front matter – 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0169-5002(03)00299-X
S18
M. Saunders et al.
1. Preface
3. Who does it
This is the first consensus document on follow up of the treated patient that has been written by the ‘‘Progress and guidelines in the management of non-small cell lung cancer’’. The document has been drawn up by doctors coming from many different cultures and philosophical backgrounds and thus varying practices in follow-up: this varies from some who saw the palliative patient frequently for cultural, philosophical as well as treatment related reasons to those who passed on the care of the palliative patient to other doctors specialising in the care of the palliative and terminal patient. Those drawing up the document recognised that there are published guidelines for follow-up in patients [1] who have been treated for non-small cell lung cancer and they in no way wish to contradict them. This document recognises the difference between countries and cultures and has drawn a consensus from all.
The initial follow-up should be done by the treating physician and afterwards by member(s) of the multidisciplinary lung cancer team. This team should have ready access to other experts and facilities including a specialist in palliative care. The team should carry out its follow-up in collaboration with the general practitioner.
2. Introduction There is a lack of evidence-based medicine to recommend a strong general policy for patient follow-up [2 /5]. For this document patient follow-up is defined as the period between treatment completion and disease relapse or progression. It is our belief that all societies have a duty to provide the cancer patient and their family with adequate support and access to care in the followup period. Factors that influence follow-up are curative intent of treatment, the stage of disease, possibility of future treatment and the presence of co-morbidity. The following recommendations reflect common practice outside clinical trials where follow-up and investigation will be defined by the protocol. The entry of patients with non-small cell lung cancer into trials is to be encouraged but this document reflects a standard of care in follow-up for those treated outside such studies. The potential benefits of follow-up include diagnosis and management of toxicities related to treatment, early diagnosis of relapse or progression [6], early detection of a second primary tumour and general support by the cancer specialist team. This support should include advice and guidance to both the patient and their family.
4. Communication All members of the multidisciplinary team and the general practitioner should be kept informed of the patient’s condition.
5. Anti-smoking Patients should stop smoking because there is a higher risk of a second primary cancer in patients who remain active smokers after treatment for a first primary lung cancer.
6. Follow-up of patients who were treated with curative intent 6.1. Frequency Initial follow-up after discharge will depend on toxicity which is evident at that time or to be anticipated. Thereafter, the interval between follow-up visits should be every 3 months for the first 2 years, every 6 months up to 5 years. Rapid and easy access to the multidisciplinary team should be available to all patients.
6.2. Investigations to be carried out at each follow-up Patients should have a careful clinical examination including a history and physical examination. A standard chest X-ray should be carried out at each visit. CT scans and other tests should be performed in case of clinical indication. There is a lack of adequate data to recommend systematic follow-up by chest CT scan.
Consensus: the follow-up of the treated patient
7. Patients treated with palliativeintent 7.1. Frequency Initial follow-up after treatment will depend on toxicity which is evident or to be anticipated. Thereafter, the interval between follow-up visits will depend on the adequacy of the control of the symptoms, in general 1 /2 months during the first 6 months. Rapid access to the multidisciplinary team should be available.
7.2. Investigations to be carried out at each follow-up Patients should have a careful clinical examination including a history and physical examination and other tests according to the clinical condition of the patient and treatment options available. A standard chest X-ray should be carried out at each visit. CT scans and other tests should be performed in case of clinical indication. There is a lack of adequate data to recommend systematic follow-up by chest CT scan.
S19
8. Conclusion Follow-up constitutes an important part of lung cancer management and this justifies studies to provide future evidence-based guidelines on this topic.
References [1] The NCCN Guideline. Non-small cell lung cancer Guideline, The Complete Library of Practice Guidelines in Oncology [CD-ROM]. Rockledge, PA: National Comprehensive Cancer Network, 2001. [2] Johnson FE, Naunheim KS, Coplin MA, Virgo KS. Geographic variation in the conduct of patient surveillance after lung cancer surgery. J Clin Oncol 1996;14:2940 /9. [3] Naunheim KS, Virgo KS, Coplin MA, Johnson FE. Clinical surveillance testing after lung cancer operations. Ann Thorac Surg 1995;60:1612 /6. [4] Virgo KS, McKirgan LW, Caputo MCA, et al. Post-treatment management options for patients with lung cancer. Ann Surg 1995;222:700 /10. [5] Younes RN, Cross JL, Deheinzelin D. Clinical investigations. Follow-up in lung cancer. How often and for what purpose. Chest 1999;115:1494 /9. [6] Westeel V, Choma D, Cle ´ment F, Woronoff-Lemsi M-C, Pugin J-F, Dubiez A, Depierre A. Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer. Ann Thorac Surg 2000;70:1185 /90.
www.elsevier.com/locate/lungcan
Consensus: the follow-up of the treated patient M. Saundersa,*, J.P. Sculierb, D. Ballc, M. Capellod, K. Furusee, P. Goldstrawf, A.P. Meertb, V. Ninaneg, Y. Oheh, M. Paesmansi, K. Parkj, R. Pirkerk, P. Postmusl, Y. Sokolowd a
Department of Radiotherapy, Mount Vernon Hospital, Rickmansworth Rd., Northwood, Middlesex, UK Department of Medical Oncology, Institut Jules Bordet, Bruxelles, Belgium c Department of Radiation Oncology, Peter Mc Callum Cancer Institute, Melbourne, Australia d Department of Thoracic Surgery, Hoˆpital Erasme, Bruxelles, Belgium e Department of Respiratory Diseases, Osaka Central Hospital, Osaka, Japan f Department of Thoracic Surgery, Brompton Hospital, London, UK g Department of Pulmonary Diseases, Hoˆpital St-Pierre, Bruxelles, Belgium h Department of Medical Oncology, National Cancer Centre, Tokyo, Japan i Department of Statistics, Institut Jules Bordet, Bruxelles, Belgium j Department of Haematology/Oncology, Samsung Medical Centre, Seoul, South Korea k Department of Oncology, Clinic for Internal Medicine I, Vienna, Austria l Department of Pulmonary Diseases, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands b
Summary This is the first consensus document on the follow-up of the treated patient with non-small cell lung cancer that has been written by this group. The document has been drawn up by doctors coming from many different cultures and philosophical backgrounds. It acknowledges that there are published guidelines on the follow-up particularly those in trials, and does not wish to contradict these. There is lack of evidence-based medicine to recommend a strong general policy in this area. For those patients who were treated with curative intent the initial follow-up will depend upon the toxicity that is evident from the treatment given. Thereafter the interval between follow-up visits should be every 3 months for the first two years, then every 6 months for up to five years. Rapid and easy access to the multidisciplinary team should be available. Full examination and chest X-ray should be carried out on each visit but other investigations should be determined by clinical need. For those patients treated with palliative intent the interval between follow-up visits once the acute reactions have settled will depend upon the adequacy of the control of the symptom and the availability of separate palliative care teams. At all times the patient should have rapid access to the multidisciplinary team and in general frequent follow-up, that is at intervals of one to two months, may be appropriate during the first six months. Follow-up constitutes an important part of lung cancer management. Efforts should be made to gain clinical material to give us evidence-based guidelines. – 2003 Elsevier Ireland Ltd. All rights reserved.
*Corresponding author. Tel.: /44-1923-844-5433; fax: /44-1923-844-167. E-mail address: [email protected] (M. Saunders). 0169-5002/03/$ - see front matter – 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0169-5002(03)00299-X
S18
M. Saunders et al.
1. Preface
3. Who does it
This is the first consensus document on follow up of the treated patient that has been written by the ‘‘Progress and guidelines in the management of non-small cell lung cancer’’. The document has been drawn up by doctors coming from many different cultures and philosophical backgrounds and thus varying practices in follow-up: this varies from some who saw the palliative patient frequently for cultural, philosophical as well as treatment related reasons to those who passed on the care of the palliative patient to other doctors specialising in the care of the palliative and terminal patient. Those drawing up the document recognised that there are published guidelines for follow-up in patients [1] who have been treated for non-small cell lung cancer and they in no way wish to contradict them. This document recognises the difference between countries and cultures and has drawn a consensus from all.
The initial follow-up should be done by the treating physician and afterwards by member(s) of the multidisciplinary lung cancer team. This team should have ready access to other experts and facilities including a specialist in palliative care. The team should carry out its follow-up in collaboration with the general practitioner.
2. Introduction There is a lack of evidence-based medicine to recommend a strong general policy for patient follow-up [2 /5]. For this document patient follow-up is defined as the period between treatment completion and disease relapse or progression. It is our belief that all societies have a duty to provide the cancer patient and their family with adequate support and access to care in the followup period. Factors that influence follow-up are curative intent of treatment, the stage of disease, possibility of future treatment and the presence of co-morbidity. The following recommendations reflect common practice outside clinical trials where follow-up and investigation will be defined by the protocol. The entry of patients with non-small cell lung cancer into trials is to be encouraged but this document reflects a standard of care in follow-up for those treated outside such studies. The potential benefits of follow-up include diagnosis and management of toxicities related to treatment, early diagnosis of relapse or progression [6], early detection of a second primary tumour and general support by the cancer specialist team. This support should include advice and guidance to both the patient and their family.
4. Communication All members of the multidisciplinary team and the general practitioner should be kept informed of the patient’s condition.
5. Anti-smoking Patients should stop smoking because there is a higher risk of a second primary cancer in patients who remain active smokers after treatment for a first primary lung cancer.
6. Follow-up of patients who were treated with curative intent 6.1. Frequency Initial follow-up after discharge will depend on toxicity which is evident at that time or to be anticipated. Thereafter, the interval between follow-up visits should be every 3 months for the first 2 years, every 6 months up to 5 years. Rapid and easy access to the multidisciplinary team should be available to all patients.
6.2. Investigations to be carried out at each follow-up Patients should have a careful clinical examination including a history and physical examination. A standard chest X-ray should be carried out at each visit. CT scans and other tests should be performed in case of clinical indication. There is a lack of adequate data to recommend systematic follow-up by chest CT scan.
Consensus: the follow-up of the treated patient
7. Patients treated with palliativeintent 7.1. Frequency Initial follow-up after treatment will depend on toxicity which is evident or to be anticipated. Thereafter, the interval between follow-up visits will depend on the adequacy of the control of the symptoms, in general 1 /2 months during the first 6 months. Rapid access to the multidisciplinary team should be available.
7.2. Investigations to be carried out at each follow-up Patients should have a careful clinical examination including a history and physical examination and other tests according to the clinical condition of the patient and treatment options available. A standard chest X-ray should be carried out at each visit. CT scans and other tests should be performed in case of clinical indication. There is a lack of adequate data to recommend systematic follow-up by chest CT scan.
S19
8. Conclusion Follow-up constitutes an important part of lung cancer management and this justifies studies to provide future evidence-based guidelines on this topic.
References [1] The NCCN Guideline. Non-small cell lung cancer Guideline, The Complete Library of Practice Guidelines in Oncology [CD-ROM]. Rockledge, PA: National Comprehensive Cancer Network, 2001. [2] Johnson FE, Naunheim KS, Coplin MA, Virgo KS. Geographic variation in the conduct of patient surveillance after lung cancer surgery. J Clin Oncol 1996;14:2940 /9. [3] Naunheim KS, Virgo KS, Coplin MA, Johnson FE. Clinical surveillance testing after lung cancer operations. Ann Thorac Surg 1995;60:1612 /6. [4] Virgo KS, McKirgan LW, Caputo MCA, et al. Post-treatment management options for patients with lung cancer. Ann Surg 1995;222:700 /10. [5] Younes RN, Cross JL, Deheinzelin D. Clinical investigations. Follow-up in lung cancer. How often and for what purpose. Chest 1999;115:1494 /9. [6] Westeel V, Choma D, Cle ´ment F, Woronoff-Lemsi M-C, Pugin J-F, Dubiez A, Depierre A. Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer. Ann Thorac Surg 2000;70:1185 /90.