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Regular follow-up after curative resection of nonsmall cell lung cancer: a real benefit for patients?

¹ Pulmonary Division, Dept of Internal Medicine, ² Institute of Pathology and ³ Dept of Cardiothoracic Surgery, University Hospital, Basel, Switzerland

CORRESPONDENCE: M. Solèr, St Claraspital, CH-4016, Basel, Switzerland. Fax: 41 616858469. E-mail: markus.soler@araspital.ch

Keywords: cost effectiveness, lung cancer, post-operative follow-up

Received: April 27, 2001
Accepted October 9, 2001

Even though complete resection is regarded as the only curative treatment for nonsmall cell lung cancer (NSCLC), >50% of resected patients die from a recurrence or a second primary tumour of the lung within 5 yrs. It remains unclear, whether follow-up in these patients is cost-effective and whether it can improve the outcome due to early detection of recurrent tumour.

The benefit of regular follow-up in a consecutive series of 563 patients, who had undergone potentially curative resection for NSCLC at the University Hospital, was analysed. The follow-up consisted of clinical visits and chest radiography according to a standard protocol for up to 10 yrs. Survival rates were estimated using the Kaplan-Meier analysis method and the cost-effectiveness of the follow-up programme was assessed.

A total of 23 patients (6.4% of the group with lobectomy) underwent further operation with curative intent for a second pulmonary malignancy. The regular follow-up over a 10-yr period provided the chance for a second curative treatment to 3.8% of all patients.

The calculated costs per life-yr gained were 90,000 Swiss Francs. The cost-effectiveness of the follow-up protocol was far above those of comparable large-scale surveillance programmes. Based on these data, the intensity and duration of the follow-up was reduced.

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