Cancer follow up: time for review.

HE regular review of patients who have received treatment in the past is a tradition in all branches of medicine. Long-term follow up is especially common in patients who have had cancer and indeed some clinicians believe that such patients should be seen on a regular basis in a hospital clinic for the rest of their lives. But now that more patients are surviving for longer periods, the time to examine this practice is long overdue. There is considerable variation in follow-up routines throughout the country and yet no variations in mortality, the final yardstick by which all cancer treatment policies must be assessed. So clearly, some follow-up visits are unnecessary; the question is, which ones? There are several logical arguments for reviewing cancer patients regularly. First, to detect at the earliest possible stage recurrences that may be asymptomatic or causing minimal discomfort. Appropriate therapy can be instituted while the size of the recurrent cancer is small, and the prospects of a cure are greatest. If no disease is found the patient can be reassured, thus allaying the fear that often surrounds this disease. Secondly, a check can be made on treatment-induced problems such as skin changes after radiotherapy or infertility after chemotherapy. Thirdly, the results of treatment, both good and bad, will become apparent to the clinician and those training in the management of cancer patients, thus optimizing treatment regimens. Finally, follow up provides an opportunity to gather precise statistics on the natural history of cancer and on the comparative efficacy of different treatments throughout the world. Do the vast clinics seen at most centres fulfil these roles adequately? Unfortunately, there is little evidence in the literature to suggest that regular follow up improves survival for patients with one of the common solid tumours. By the time a recurrence is detected, even using tl4e most sensitive screening procedure, it is unlikely to be curable by current therapies. The exceptions are a few rare tumours, such as testicular cancer, where the combination of precise tumour markers and effective salvage therapy coexist.' It has yet to be shown for tumours of the lung, breast and colon that a recurrence detected in the clinic carries a better prognosis than one detected at a symptomatic stage by the patient. Studies to examine this aspect of cancer care would be welcome indeed. For the patient, follow up is a mixed blessing. Some welcome the …