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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.
Patients’ 5-year recurrence rates were no different based on the intensity of surveillance: stage 2 and 3 patients who underwent high-intensity imaging and CEA testing had a slightly higher resection rate, without any improvement in 5-year OS.

The authors concluded that higher intensity surveillance was not associated with earlier detection of recurrent disease or improved OS. It did, however, result in a slightly higher resection rate. They went on to recommend less frequent testing for surveillance in patients with CRC.

Van Loon praised the highly annotated design and large real-world sample of patients used by the trial. “The findings add to results of FACS and GILDA trials, so intensive follow-up may not improve OS for CRC survivors,” she added.

Questions remain about whether a subset of patients with recurrence may benefit from more intensive surveillance, Van Loon concluded.

The final abstract discussed was the receipt of recommended surveillance with imaging in survivors of early stage NSCLC.

Lifelong imaging surveillance for early cancer detection is recommended in lung cancer survivors who have a high risk for recurrence and second cancers and a 5-year survival of only 50%. The authors of the study examined the rates and determinants of regular surveillance imaging in NSCLC survivors.

Examination of the SEER-Medicare linked database identified 10,680 patients with stage I and II NSCLC, diagnosed over the 10 years between 2001 and 2011 and treated with surgery. Patients were censored at the time of recurrence/second cancer, loss of insurance or 3 months before death. In this population, receipt of computerized tomography and/or positron emission tomography imaging during the surveillance periods of 7 to 18, 19 to 30, 31 to 42, and 43 to 60 months from the date of surgery was assessed.

The study found that 79% and 40% survivors had follow-up information until the end of 30- and 60-month surveillance periods, respectively. With a median follow-up of 7.6 years, 71% of the survivors received imaging in the first 18 months after surgery, but only 56% and 44% of survivors continued to receive regular imaging by 30- and 60-month of follow-up periods, respectively.

Survivors, the analysis found, were less likely to receive imaging if they were older (≥80 years), black, not married, had rural residence, did not receive adjuvant therapy, had stage I disease (compared to stage II) and were diagnosed in 2006 or earlier. In adjusted analysis, survivors receiving recommended imaging up to 18 months from surgery had improved survival compared to survivors who did not (Hazard ratio [HR], 0.86; 95% CI, 0.81 to 0.92). Survival benefit was also observed in survivors who had regular imaging up to 5 years from surgery (HR, 0.68; 95% CI, 0.60 to 0.76).

The fact that more than 50% of the lung cancer survivors did not receive recommended long-term surveillance imaging had the authors conclude that adherence to regular surveillance even at 5 years from initial surgery is associated with improved survival.

Van Loon noted that the large cohort size was a definite plus for the study, as was the use of the SEER-Medicare linked database. The limitations of the study were that it was retrospective, was missing the population younger than 66 years, and did not use non-Medicare sources. Additionally, 60% of patients were missing follow-up at 60 months.

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