Cancer Treatment Today

Gudelines for folowup of cancer patients are sparse. Among the few cancer types is lung. (The following is from the article by Colice et al:

1. In lung cancer patients who have been treated with curative-intent therapy, the follow-up for complications related to the curative-intent therapy should be managed by the appropriate specialist and should probably last 3 to 6 months. At that point, the patient should be reevaluated by the multidisciplinary tumor board for entry into an appropriate surveillance program for detecting recurrences and/or metachronous tumors. Level of evidence, poor; benefit, moderate; grade of recommendation, C
2. In lung cancer patients who have been treated with curative-intent therapy, surveillance with a medical history, physical examination, and imaging study (either chest radiograph or chest computed tomography [CT] scan) is recommended every 6 months for 2 years and then annually. Patients should be counseled on symptom recognition and should be advised to contact their physician if worrisome symptoms are recognized. Level of evidence, poor; benefit, moderate; grade of recommendation, C
3. Ideally, surveillance for the recognition of a recurrence of the original lung cancer and/or the development of a metachronous tumor should be coordinated through a multidisciplinary team approach. This team should develop a lifelong surveillance plan appropriate for the individual circumstances of each patient immediately following initial curative-intent therapy. If possible, the physician who diagnosed the primary lung cancer and initiated the curative-intent therapy should remain as the health-care provider overseeing the surveillance process. Level of evidence, poor; benefit, moderate; grade of recommendation, C
4. In lung cancer patients following curative-intent therapy, the use of blood tests, positron emission tomography (PET) scanning, sputum cytology, tumor markers, and fluorescence bronchoscopy is not currently recommended for surveillance. Level of evidence, poor; benefit, negative; grade of recommendation, D
5. Lung cancer patients who smoke should be strongly encouraged to stop smoking. Level of evidence, fair; benefit, moderate; grade of recommendation, B

NCCN 2017 recommends CT every 6 months for two years and then annually, then annual low dose CT. For oligometastatic disease:

H&P and chest CT ± contrast every 3–6 mo for 3 y, then H&P and chest CT ± contrast every 6 mo for 2 y, then H&P and a low-dose non-contrast-enhanced chest CT annually.

Colice GL, Rubins J, Unger M. Follow-up and surveillance of the lung cancer patient following curative-intent therapy. Chest 2003 Jan;123(1 Suppl):272S-83S.

nccn.org, Non-small Cell Lung Cancer, 2013.