Who should follow up lung cancer patients after operation?

Background. It is unclear whether follow-up by a thoracic surgeon after lung cancer resection alters survival. Methods. The charts of 245 early stage (less than or equal to IIB) nonsmall cell lung cancer patients, diagnosed between 1988 and 1995, were reviewed. Follow-up data were complete to January 1, 1997 in 96.3% (236 of 245) of cases. Results. Ninety of the 111 recurrences were detected before discharge from the thoracic clinic. Despite clinic follow-up, 66.7% (60 of 90) were identified by the family physician, and only 28.9% (26 of 90) by the surgeon. The remaining 4.4% (4 of 90) were detected by other physicians. Ninety-six percent (25 of 26) surgeon-detected recurrences had suspicious clinical or chest radiographic findings, compared with 92% for family physician-detected recurrences (55 of 60; not significant). The cost per recurrence detected by surgeons was Can $4,367. A. 75% cost savings could ensure if patients were followed up by their family physician. There was no 5-year survival benefit for patients whose recurrence was detected by the surgeon. Conclusions. Long-term follow-up after limited-stage non-small cell lung cancer resection could possibly be performed by a family physician alone without compromising overall survival, and with significant cost savings. (C) 2000 by The Society of Thoracic Surgeons.