Introduction and objectives International guidelines suggest regular CT scan follow-up for non-small-cell lung cancer (NSCLC) that is surgically treated with curative intent.1,2 NICE guidance does not specify the type or frequency of imaging. Our aims were to assess current follow-up practice in such patients in our region, and estimate the potential impact of implementing international guidelines.
Methods We surveyed a majority of hospitals (six NHS trusts) in our region about their current follow-up practice. A retrospective study was performed of patients in our trust who underwent curative surgery for NSCLC between March 2013 and December 2014.
Results None of the surveyed trusts were following ESMO or ACCP guidelines. Only two had a local policy in place. The majority used chest X-ray (CXR) rather than CT follow-up, which reflected our practice.
We identified 79 patients who had undergone surgery with curative intent in our trust. 5 patients were excluded, as notes were unavailable for 2, and 3 died before any follow-up. Amongst the remaining 74 patients, follow-up was for a mean of 19 months. During this time the mean number of CTs and CXRs per patient was 1.3 and 2.7 respectively. Following ESMO guidelines would reduce the number of CT scans compared to our overall current practice, to 1.1 per patient,1 whilst ACCP guidelines would result in an increase to 2.7 CTs per patient.2
Conclusions Most patients in our region are followed-up by CXR rather than CT. Most hospitals are not using follow-up guidelines, resulting in practice variation. Compared to current practice in our trust, following ESMO guidelines would not result in an increase in CT scans for this purpose, and no CXRs would be required for routine follow-up. Therefore it may be feasible to adopt this more uniform, evidence-based approach.
Vansteenkiste J, Crino L, Dooms C, et al. 2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Annals of Oncology 2014;25:1462–1474.
Colt H, Murgu S, Korst R, et al. Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2013;143(5 Suppl):e437S–e454S.