I seem to know more about maintaining my car than ensuring my husband is getting at least the basic level of follow-up care. Is there an accepted protocol that lists the minimum types and frequency of follow-up tests after initial treatment for a completely uncomplicated case? For example, PFT at 6, 8, 20 months after surgery; chest x-rays every 4 months, etc. I suppose more frequent testing can be ordered based on the individual's presentation but I am looking for the bare minimum.
We had a situation with my husband's neuro condition where one provider said "see you in a year" and another provider's protocol was every 2 weeks after surgery for some period of time then less frequent.
PS: I must confess that I do not change my oil every 3,000 miles either!
Thank you for your consideration of this question.
Best regards,
Lisa
Reply # - March 12, 2014, 08:58 AM
Reply To: Frequency and Type of Tests Following Pneumonectomy &
This link discusses the standard of care post surgery, http://cancergrace.org/lung/2008/08/10/fu-after-resection/
I hope it's helpful,
Janine
Reply # - March 12, 2014, 02:43 PM
Reply To: Frequency and Type of Tests Following Pneumonectomy &
The basic conclusion is that there is no consensus and really no clear evidence to speak to this question -- hence the lack of any consensus. I and many other lung cancer specialists typically do CT scans every 3-6 months after surgery or chemo/radiation for the first few years, less frequently with further time since treatment, and then annually after several years. I personally find chest x-rays to be of so little value that I think they have no meaningful value in following up after treatment; they are more just something to do that gives a vague sense of doing something, but the amount of information you get from a CT is orders of magnitude greater.
My personal approach, which I understand is shared by many of my colleagues, is to repeat a chest CT scan every 4 months in the first year and every 6 months from years 2-4 for resected stage IB-IIIA NSCLC after surgery, then annually. For stage IA, I'd be more inclined to do a scan every 6 months right from the beginning and might transition to annual scans a year earlier, depending on the specifics of the case. For patients who have undergone chemo/radiation for stage IIIA or IIIB NSCLC, I'm more inclined to scan every 3-4 months for 12-18 months before following the every 6 month and eventual annual plan.
Finally, now that low dose chest CT scans are becoming more widely available for lung cancer sceening, I'm becoming more interested in doing low dose CTs than full diagnostic CTs with contrast and higher radiation exposure. There's no careful study of the value of one vs. another in this setting, but I think it makes sense to move toward lower dose non-contrast chest CT scans after 18-24 months as we become increasingly optimistic that we'll be following and doing surveillance scans on patients for a very long time.
Good luck.
-Dr. West
Reply # - March 12, 2014, 02:46 PM
Reply To: Frequency and Type of Tests Following Pneumonectomy &
One thing I might also add is that I didn't mention post-surgical PET/CT scans because there is no evidence that they improve outcomes, they cost 10 times as much as a CT scan, and there is a growing movement in the oncology world to stop wasting health care resources unnecessarily by doing PET/CT scans for routine surveillance unless or until there is evidence to show that this practice leads to better outcomes for patients.
-Dr. West