De-escalation of post-treatment surveillance in oropharyngeal cancer

Head Neck. 2019 May;41(5):1457-1462. doi: 10.1002/hed.25593. Epub 2018 Dec 23.

Abstract

Background: The majority of new oropharyngeal squamous cell carcinoma (OPSCC) cases are associated with human papillomavirus and favorable prognosis. Post-treatment follow-up should be targeted to patients at greatest risk for disease recurrence.

Methods: To assess the benefits of routine clinical surveillance in OPSCC, we reviewed all follow-up visits conducted in 2014 at Helsinki University Hospital Department of Otorhinolaryngology.

Results: Of 366 visits, 26 (7%) were from patients presenting with a new symptom, and disease recurrence was detected in four. The presence of a new symptom was significantly associated with disease recurrence (P < 0.001). Of 366 visits, 340 (93%) were from patients presenting without new symptoms, and not a single recurrence was found during these visits.

Conclusions: Based on our findings, and previous studies assessing the prognosis and pattern of recurrent OPSCC, we concluded that the number of routine post-treatment visits can be reduced. Follow-up should rather focus on symptom-directed examinations.

Keywords: follow-up; human papillomavirus; oropharyngeal cancer; recurrence; squamous cell carcinoma.

MeSH terms

  • Ambulatory Care Facilities / statistics & numerical data
  • Cancer Survivors
  • Carcinoma, Squamous Cell / diagnostic imaging*
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Cohort Studies
  • Continuity of Patient Care*
  • Female
  • Finland
  • Follow-Up Studies
  • Hospitals, University
  • Humans
  • Incidence
  • Male
  • Neoplasm Invasiveness / pathology
  • Neoplasm Recurrence, Local / diagnostic imaging*
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Oropharyngeal Neoplasms / diagnostic imaging*
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / therapy*
  • Papillomavirus Infections / epidemiology
  • Papillomavirus Infections / pathology
  • Positron Emission Tomography Computed Tomography / methods
  • Prognosis
  • Retrospective Studies
  • Risk Assessment