Follow-up patients who have been treated for head and neck cancer
Change in patient symptoms during follow up is the most frequent
indication of recurrent disease and must be regarded seriously, even if
clinical examination reveals no abnormalities 14.
INTEGRATE, the UK Trainee Research Collaborative Network, performed a UK
national audit of patients who underwent 5,123 follow-up consultations
after treatment for HNC in 89 hospitals across the
UK15. Residual or recurrent disease rates were 57% at
2 years, 32% between 2-5 years, and 11% post-5 years Follow-up
appointments expedited by either the patient or the clinician due to
clinical concern correlated significantly with the presence of residual
or recurrent disease, or a second primary tumour (p=0.0001). The pick-up
rate was 35% in expedited appointments compared to 5.2% in planned
follow-ups. Of the expedited appointments, 63% were initiated by
patients versus 37% by clinicians (Table 1)
Parallels exist in other cancer sites where remote follow up is
performed based on patent symptomatology and blood markers. Qaderi et
al16 optimized an innovative electronic medical record
application for patients with colorectal cancer. Patients can review
their appointments and test results, symptoms are monitored using online
questionnaires; the long term results are awaited. However, in these
resource constrained times, rapid innovation and dissemination of new
care models is needed, which, with careful data collection and robust
governance, can define new standards without causing patient harm.