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Survival benefits from follow-up of patients with lung cancer patients: a systematic review and meta-analysis

Survival benefits from follow-up of patients with lung cancer patients: a systematic review and meta-analysis
Survival benefits from follow-up of patients with lung cancer patients: a systematic review and meta-analysis


Introduction: The burden of lung cancer is high for patients and carers. Care after treatment may have the potential to impact on this. We reviewed the published literature on follow-up strategies intended to improve survival and quality of life.

Methods: We systematically reviewed studies comparing follow-up regimes in lung cancer. Primary outcomes were overall survival (comparing more intensive versus less intensive follow-up) and survival comparing symptomatic with asymptomatic recurrence. Quality of life was identified as a secondary outcome measure. Hazard ratios (HRs) and 95% confidence intervals from eligible studies were synthesized.

Results: Nine studies that examined the role of more intensive follow-up for patients with lung cancer were included (eight observational studies and one randomized controlled trial). The studies of curative resection included patients with non-small cell lung cancer Stages I to III disease, and studies of palliative treatment follow-up included limited and extensive stage patients with small cell lung cancer. A total of 1669 patients were included in the studies. Follow-up programs were heterogeneous and multifaceted. A nonsignificant trend for intensive follow-up to improve survival was identified, for the curative intent treatment subgroup (HR: 0.83; 95% confidence interval: 0.66–1.05). Asymptomatic recurrence was associated with increased survival, which was statistically significant HR: 0.61 (0.50–0.74) (p < 0.01); quality of life was only assessed in one study.

Conclusions: This meta-analysis must be interpreted with caution due to the potential for bias in the included studies: observed benefit may be due to systematic differences in outcomes rather than intervention effects. Some benefit was noted from intensive follow-up strategies. More robust data, in the form of randomized controlled trials, are needed to confirm these findings as the review is based primarily on observational studies. Future research should also include patient-centered outcomes to investigate the impact of follow-up regimes on living with lung cancer and psychosocial well-being.
1556-0864
1993-2004
Calman, Lynn
9ae254eb-74a7-4906-9eb4-62ad99f058c1
Beaver, Kinta
937abce1-493d-4643-ace0-b76a6416fd14
Hind, Daniel
d0246cbf-e8b6-45c2-9412-76e0988852f3
Lorigan, Paul
a996ae96-91af-4ba9-8b66-be50cca03809
Roberts, Chris
6b8da39a-79b9-478e-8170-32f40ad4ef3f
Lloyd-Jones, Myfanwy
6ffcf671-cd13-4d31-a826-09ea743b6e07
Calman, Lynn
9ae254eb-74a7-4906-9eb4-62ad99f058c1
Beaver, Kinta
937abce1-493d-4643-ace0-b76a6416fd14
Hind, Daniel
d0246cbf-e8b6-45c2-9412-76e0988852f3
Lorigan, Paul
a996ae96-91af-4ba9-8b66-be50cca03809
Roberts, Chris
6b8da39a-79b9-478e-8170-32f40ad4ef3f
Lloyd-Jones, Myfanwy
6ffcf671-cd13-4d31-a826-09ea743b6e07

Calman, Lynn, Beaver, Kinta, Hind, Daniel, Lorigan, Paul, Roberts, Chris and Lloyd-Jones, Myfanwy (2011) Survival benefits from follow-up of patients with lung cancer patients: a systematic review and meta-analysis. Journal of Thoracic Oncology, 6 (12), 1993-2004. (doi:10.1097/JTO.0b013e31822b01a1). (PMID:21892108 )

Record type: Article

Abstract



Introduction: The burden of lung cancer is high for patients and carers. Care after treatment may have the potential to impact on this. We reviewed the published literature on follow-up strategies intended to improve survival and quality of life.

Methods: We systematically reviewed studies comparing follow-up regimes in lung cancer. Primary outcomes were overall survival (comparing more intensive versus less intensive follow-up) and survival comparing symptomatic with asymptomatic recurrence. Quality of life was identified as a secondary outcome measure. Hazard ratios (HRs) and 95% confidence intervals from eligible studies were synthesized.

Results: Nine studies that examined the role of more intensive follow-up for patients with lung cancer were included (eight observational studies and one randomized controlled trial). The studies of curative resection included patients with non-small cell lung cancer Stages I to III disease, and studies of palliative treatment follow-up included limited and extensive stage patients with small cell lung cancer. A total of 1669 patients were included in the studies. Follow-up programs were heterogeneous and multifaceted. A nonsignificant trend for intensive follow-up to improve survival was identified, for the curative intent treatment subgroup (HR: 0.83; 95% confidence interval: 0.66–1.05). Asymptomatic recurrence was associated with increased survival, which was statistically significant HR: 0.61 (0.50–0.74) (p < 0.01); quality of life was only assessed in one study.

Conclusions: This meta-analysis must be interpreted with caution due to the potential for bias in the included studies: observed benefit may be due to systematic differences in outcomes rather than intervention effects. Some benefit was noted from intensive follow-up strategies. More robust data, in the form of randomized controlled trials, are needed to confirm these findings as the review is based primarily on observational studies. Future research should also include patient-centered outcomes to investigate the impact of follow-up regimes on living with lung cancer and psychosocial well-being.

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More information

Published date: December 2011
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 366308
URI: https://eprints.soton.ac.uk/id/eprint/366308
ISSN: 1556-0864
PURE UUID: 008ea7ee-09db-4b35-abfe-75dae71851f7
ORCID for Lynn Calman: ORCID iD orcid.org/0000-0002-9964-6017

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Date deposited: 04 Jul 2014 15:54
Last modified: 20 Jul 2019 00:43

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