BACKGROUND Routine follow‐up offered to patients with laryngeal carcinoma in The Netherlands consisted of 22 routine visits over a time period of 10 years after treatment. The primary aims of the follow‐up were to detect cancer recurrence in asymptomatic patients and to achieve better survival outcome by reducing cancer‐specific mortality rates. METHODS A longitudinal cohort study was performed to evaluate the effect of this follow‐up schedule. Between January 1990 and January 1995, the authors studied all patients with primary laryngeal squamous cell carcinoma who were treated with intention to cure. For patients who developed cancer recurrence, all routine and extra visits were documented. Reported symptoms and physical evidence of tumor were mapped. RESULTS The patients complied with the follow‐up protocol closely. In only 2% of all routine visits an asymptomatic cancer recurrence was found. There was no difference in survival and tumor mortality rates for patients with and without symptoms, despite the difference in whether the therapy applied had the intention to cure. It seemed that patients who developed tumor recurrence after therapy for laryngeal carcinoma received no benefit from screening for cancer recurrence detection. The lack of benefit for cancer detection screening among asymptomatic patients might be explained by unfavorable tumor biology parameters. CONCLUSIONS The routine follow‐up program after treatment for laryngeal carcinoma did not lead to survival benefit for asymptomatic patients with tumor recurrence. Cancer 2004. © 2004 American Cancer Society.

Risk profiles for locoregional relapse were defined. Intensifying the follow-up schedule is not advisable because the lead time is very short. An excessively high number of routine visits would have to be performed to increase the detection rate for asymptomatic recurrences.

Screening by chest x-ray examination to detect lung cancer in an asymptomatic stage after curative treatment for squamous cell laryngeal cancer does not improve survival for patients who develop lung cancer.

BACKGROUND.Routine follow‐up is offered to all patients with laryngeal cancer who are treated with curative intent. Although time and resources are devoted to surveillance, the effect of asymptomatic recurrence detection is not well understood. For this study, the authors evaluated the effect that routine follow‐up may have on life expectancy and disease‐specific mortality rate for patients with laryngeal cancer.METHODS.Using a Markov model, a cohort simulation was performed on 4 hypothetical age groups of patients with laryngeal cancer. Three different follow‐up strategies were compared—the current schedule, no follow‐up, and the perfect follow‐up—in which all recurrences were detected asymptomatically. Sensitivity analyses were performed to study the impact of variations in the transition rates on life expectancy.RESULTS.Compared with no follow‐up, the current schedule showed a gain in life expectancy with a range from 0.3 years to 1.5 years that decreased with advancing age. Abolishing the current follow‐up schedule raised the disease‐specific mortality rate; the increase ranged from 2.8% to 5.9%. Variations of ±25% in the transition rates produced only a modest effect on life expectancy.CONCLUSIONS.A small reduction in life expectancy was observed when follow‐up was withheld from the majority of patients. Disease‐specific mortality rates rose when no follow‐up was provided. These rates probably were overestimated. A simplified version of the current follow‐up protocol may be implemented. Cancer 2007. © 2006 American Cancer Society.

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