A120
Does intensive follow-up of lung cancer patients improve survival?: a systematic review and meta-analysis
Lynn Calman1, Kinta Beaver1, Daniel Hind2, Myfanwy Lloyd-Jones2
1The University of Manchester, Manchester, Lancashire, UK, 2The University of Sheffield, Sheffield, Yorkshire, UK
Background
Globally lung cancer is a major cause of mortality and morbidity. Despite advances in treatment, patients continue to have a poor prognosis and experience a high symptom burden. As the cancer agenda in England is increasingly focusing on survivorship and living with cancer, it is timely that a systematic review is undertaken to assess the current evidence for follow-up of lung cancer patients. This review aims to examine the impact of intensive follow-up on survival.b
Method
English language observational studies and randomised clinical trials (RCTs) were retrieved from electronic databases (Ovid Medline, Embase, PsychINFO, CINAHL, BNI, Cochrane Library and National Research Register). All studies were scrutinised for quality. If there was more than one study with like populations, interventions and outcomes, the relevant data were statistically synthesised. Time to event data were synthesised using hazard ratios (HR) and 95% confidence intervals.
Results
Nine studies that examined the role of intensive follow-up for lung cancer patients were included in the review (eight observational studies and one RCT). This meta-analysis shows that there is a trend for intensive follow-up to improve survival in patients with lung cancer, although this result is not statistically significant for the NSCLC (curative intent treatment) group (HR 0.82, CI 0.64-1.05) or the SCLC/advanced NSCLC (palliative treatment) group (HR 0.69, CI 0.46-1.04). For patients with potentially resectable NSCLC there is a statistically significant difference in survival between asymptomatic and symptomatic recurrence (HR 0.59, CI 0.48-0.72), although this is complicated by lead time bias.
Conclusion
There is no evidence that intensive follow-up of lung cancer patients improves survival compared to standard or less intensive follow up. However, because this finding is based on observational studies with potential for bias, further evidence, ideally from RCTs, is needed. The review identified limited reporting of patient centred quality of life outcomes.
