In Post-Surgery Lung Cancer Surveillance, More Is Not Better
An annual CT screening is better than frequent follow-up scans, a new study reports.
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For people who have had cancer surgery, post-surgical surveillance -- usually at intervals of three, six and 12 months -- is standard care. But the reasoning behind such monitoring, including decisions on the best methods to use and their frequency, has been based on expert opinion and limited empirical data such as small retrospective studies. The Institute of Medicine lists establishing the efficacy of post-surgical surveillance among its most urgent goals.
A five-year study published in the October 2018 Annals of Surgery tackles that goal with a look at lung cancer. The study reveals that frequent surveillance does not improve lung cancer patient survival. Researchers from some of the United States’ largest public health and cancer treatment centers, along with medical societies including the American College of Surgeons, evaluated surveillance among non-small-cell lung cancer (NSCLC) patients. The researchers chose NSCLC because, they wrote, it is the “fourth leading diagnosis among cancer survivors ... that affects 450,000 Americans and is expected to grow 20 percent by 2022.” A database of 4,463 NSCLC survivors representative of the national patient population was abstracted from the National Cancer Database. These patients had been followed for five years and undergone routine follow-up CT scans.
Although a higher number of scans was not associated with better survival, the authors find reason for optimism. NSCLC patients have historically had a poor chance of surviving a recurrence, but the National Lung Screening Trial has shown that annual low-dose CT scans found smaller NSCLC tumors at earlier stages, reducing lung cancer mortality by 20 percent. The authors of the current study believe this finding justifies annual CT screening even as it also creates many more patients needing post-surgery surveillance. But their own findings indicate a more frequent schedule is not warranted, and absent the presence of other serious conditions, patient care would not be compromised by reducing the frequency of ineffective and expensive scans.