What follow-up is needed after treatment of lung cancer?

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Careful follow-up by a physician expert in the care of lung cancer is mandatory.

The incidence of second cancers is very high and cure of these cancers is possible if they are detected at an early stage.

Cure is also possible in some cases if recurrent tumor is discovered at an early stage.

Appropriate palliative measures should be instituted as early as possible.

My usual plan is to see the patient one week following discharge and at six weeks post-op to be sure that no post-operative complications have occured and to be sure that proper consultations have been obtained, if adjuvant therapy is indicated.

The patient is then seen at four month intervals for the next two years, when the chance of recurrence is highest, and at six month intervals thereafter, for the rest of his life.

At follow up, a history and physical examination are done. This examination should include all items mentioned in the pre-operative examination. Special attention is paid to functional status and possible recurrence of tumor.

Laboratory studies performed include a complete blood count, a chemistry panel and a carcinoembryonic agent (CEA) level. PFTs are done at four months to establish the function of the lungs after surgery. A chest x-ray is imperative. It is not my practice to do routine CT or MRI scans of the chest, but they are ordered selectively in case abnormalities are seen on CXR. Bone and brain studies are done only if abnormalities are detected on H+P.

HMOs are recently maintaining that follow-up of lung cancer patients need not be done by specialists, and can be safely and effectively done by family practitioners. In my experience this is not the case. I note delayed recognition of recurrence and second tumors, and improper management of these events when follow-up is not managed by an expert. Furthermore, I have found that follow-up by inexperienced physicians is usually more expensive, because inappropriate tests are more frequently ordered.

I have recently had the discouraging experience of finding three patients who are cured of the first lung cancer return with an incurable second lung cancer. One patient had discontinued follow-up. The other two patients were on a yearly follow-up. Because of this experience I have changed my former practice and now advocate that any patient who has had a lung cancer needs to be seen no less frequently than at six month intervals for the rest of his life. It is also increasingly clear that chest x-rays are insufficiently accurate in picking up early lung cancer. It may be that a chest computerized tomogram may need to be done at least yearly in these patients.

There is currently a dearth of information on clinical follow-up of patients after treatment of lung cancer.

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