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Do We Have Adequate Surveillance in Cancer Survivor Care?

Surabhi Dangi-Garimella, PhD
A poster discussion session at the 2017 Annual Meeting of the American Society of Clinical Oncology examined retrospective surveillance data in 3 different cancers: non-small cell lung cancer, head and neck cancer, and colorectal cancer.
Survivor care is important among patients who have undergone treatment for cancer. Survivorship care and follow-up can help patients discuss issues that may be associated with their treatment, share their financial concerns, and, most importantly, ensure disease-free survival. A poster discussion session at the 2017 Annual Meeting of the American Society of Clinical Oncology examined retrospective surveillance data in 3 different cancers: non-small cell lung cancer (NSCLC), head and neck cancer (HNC), and colorectal cancer (CRC). Katherine Van Loon, MD, MPH, from the University of California, San Francisco, was the discussant.

The first study, conducted by researchers affiliated with multiple healthcare systems in Philadelphia, Pennsylvania, evaluated the impact of radiation therapy and latency period on the risk of developing new primary lung cancers after a head and neck cancer after HNC.

The population-based study of 85,154 patients with HNC in the Surveillance, Epidemiology, and End Results (SEER) database found a total of 4209 patients with new primary lung cancers. Compared with the no radiation group, those who received radiation therapy had a higher incidence of the primary lung cancers across all latency periods, from less than 1 year (standardized incidence ratio, 3.45 vs 2.18, respectively) to 10 to 15-year follow-up (standardized incidence ratio, 3.19 vs 1.88, respectively). The highest incidence for the radiation-treated group was observed in the 1 to 3-years latency period (4.57 vs 2.41).

The authors concluded that in patients with HNC, the risk of developing a new primary lung cancer is associated with radiation treatment, with the greatest risk observed within 10 years of the initial HNC diagnosis. They also recommend that screening for patients who smoke should be considered, especially within 10 years of the primary HNC diagnosis.

Van Loon said that while the large historic sample size from the SEER data was a significant strength of the study, retrospective analysis place limitations on the observations. Further, the predominance of squamous cell carcinoma raises questions on de-novo vs metastatic nature of the observed lung cancer. She also pointed out the lack of data on patient exposure to risk factors as a study limitation.

The next study evaluated the impact of post-treatment surveillance in CRC with the purpose of this study was to determine if the intensity of post-treatment surveillance is associated with time to recurrence detection, treatment, or overall survival (OS). The authors examined the primary records of 10,636 stage I to III patients with CRC from Commission on Cancer accredited hospitals who were diagnosed between 2006 and 2007, and data was merged with records in the National Cancer Database. A predicted and observed number of imaging and carcinoembryonic antigen (CEA) tests per patient were determined and clustered by hospital; patients were then categorized into high or low intensity categories.

Of the 6279 patients, those who underwent high-intensity imaging (50.6%) or CEA surveillance (51.2%) in the 3 years after CRC treatment, had a mean of 2.9 imaging studies and 4.7 CEA tests. Patients with low-intensity imaging underwent a mean of 1.4 imaging studies and 1.6 CEA tests.

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