Chest
Follow-up and Surveillance of the Patient With Lung Cancer After Curative-Intent Therapy: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Section snippets
Summary of Recommendations
3.5.1. In patients who have undergone curative-intent surgical resection of non-small cell lung cancer (NSCLC), it is suggested that chest CT be performed every 6 months for the first 2 years after resection and every year thereafter (Grade 2C).
3.5.2. For patients with NSCLC or carcinoid tumor who have undergone curative-intent therapy, it is recommended that the original treating physicians participate in the decision-making process during the follow-up and surveillance (Grade 1C).
3.5.3. After
Study Identification
This study was undertaken to update the previous ACCP recommendations11 regarding follow-up and surveillance of patients with lung cancer following curative-intent therapy. Meta-analysis of Observational Studies in Epidemiology guidelines were followed in the development of this systematic review.12 Systematic methods were used to identify relevant studies, assess study eligibility for inclusion, and evaluate study quality.13, 14 We attempted to retrieve all published studies that reported on
Summary of Other Published Guidelines
A patient-centered approach to cancer care mandates that health-care providers consider patient preferences in the decision-making process. Patients view follow-up favorably and prefer to be seen by medical staff in a clinic, with nurse-led care as an acceptable option. Follow-up by primary-care physicians or telephone calls are viewed less favorably.16 The 2007 ACCP guidelines pertaining to follow-up and surveillance after curative-intent therapy summarized results from the guidelines of other
The Role of Imaging Studies
Since the publication of the 2007 ACCP guidelines, several new studies were published that address the performance of imaging following curative-intent therapy (Table S2).
The Role of HRQOL
Only a handful of studies have assessed HRQOL following lung resection. Many analyses are limited by small study population size, cross-sectional study design, retrospective data analysis, or the use of nonvalidated assessments. Furthermore, the studies identified by our search addressed QOL after potentially curative interventions for patients with stage I to III lung cancer (Table S3). Although this reflects stages of disease appropriate for curative-intent treatment, it also signifies a
The Role of Tumor Markers
In solid tumors other than lung cancer, biomarkers help in diagnosis, determine response to treatment, and serve as a tool for detecting recurrence. These biomarkers include, but are not limited to, prostate-specific antigen in prostate cancer, carcinoembryonic antigen (CEA) in colon cancer, and cancer antigen 125 in ovarian cancer. Changes in biomarker levels in a specific individual during the disease course or after curative-intent therapy could be informative in estimating the efficacy of
The Role of Bronchoscopy
The exact role for bronchoscopy as a follow-up method in all patients who undergo curative-intent therapy remains unclear. Only a few case series address this issue. Studies of surveillance protocols that used bronchoscopy in addition to CT scanning show that when the costs of retreatment (ie, surgical intervention) were included,53 the cost per life-year gained was $56,000 compared with a (deemed) acceptable threshold of £20,000 to £30,000 per life-year gained in the United Kingdom and $50,000
Questions for Future Research
Our review of the literature identifies the paucity of well-designed prospective studies and large rigorous case series specifically targeting follow-up and surveillance issues. Authors of future guidelines and, of course, practitioners and patients would greatly benefit from future investigations targeting these issues. Our literature search did not identify studies that could unequivocally answer the PICO questions described in the Methods section. In the following paragraphs, therefore, we
Summary
The goals of follow-up and surveillance programs after patients have undergone curative-intent therapy are to identify and potentially manage treatment-associated morbidity, detect and potentially treat disease recurrence or new primary tumors, enhance QOL, and improve survival. Much of the evidence supporting various aspects of surveillance protocols, however, remains relatively weak and based on studies of lesser quality. In this review, we chose to complement the existing ACCP guidelines on
Acknowledgments
Author contributions: Dr Colt had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Colt: contributed as editor and oversaw the development and writing of this article, including the data analysis and subsequent development of the recommendations contained herein.
Dr Murgu: contributed as deputy editor and collected and analyzed data from eligible studies.
Dr Korst: contributed as imaging section editor and
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Funding/Sponsors: The overall process for the development of these guidelines, including matters pertaining to funding and conflicts of interest, are described in the methodology article.1 The development of this guideline was supported primarily by the American College of Chest Physicians. The lung cancer guidelines conference was supported in part by a grant from the Lung Cancer Research Foundation. The publication and dissemination of the guidelines was supported in part by a 2009 independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.
COI grids reflecting the conflicts of interest that were current as of the date of the conference and voting are posted in the online supplementary materials.
Disclaimer: American College of Chest Physicians guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://dx.doi.org/10.1378/chest.1435S1.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.