respiratory
Lung cancer

Questions raised about follow-up after lung cancer treatment


More work is needed to clarify optimal surveillance of patients following curative treatment for lung cancer, the Asian Pacific Society of Respirology (APSR) Congress in Sydney was told.

Dr Emily Stone, a senior staff specialist in thoracic medicine at St Vincent’s Hospital, said preliminary data from the IFCT-0302 trial showed the addition of CT scans with or without bronchoscopy had no more effect on survival than a clinical exam and chest X-ray.

The French study of patients with resected non-small cell lung cancer found no difference in overall survival between the two groups after two years.

Dr Stone told the limbic the preliminary data did not rule out a benefit with longer follow-up.

“There are no robust data to follow at the moment so we all do what we do. Most of us, with guidelines based on expert opinion and consensus, do follow-up with six-monthly CTs for the first couple of years then if the patient is well, yearly to five years.”

“But there is no really good data to support that and now we are getting some data that is questioning the benefits of those six-monthly scans.”

She said the data also suggested there was possibly more benefit from detecting second primary cancers than recurrences.

“It’s not saying we shouldn’t detect recurrence and treat it – we don’t have any evidence of that yet – but there is a possible argument that, in some cases, you should wait.”

Dr Stone added frail patients or those with significant co-morbidities might not be strong enough for another round of treatment should a recurrence be detected.

“It’s really hard to know when you should routinely scan to do the right thing by your patients.”

She said there was a need for better surveillance tools and more research into efficacy, cost effectiveness and impact on issues such as anxiety.

“Psychological impact has been looked at in the context of screening but less so relating to follow-up.”

She said Australian guidelines were currently under review.