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.