Follow up after Primary Treatment of Soft Tissue Sarcoma: A Survey of Current Practice in the United Kingdom

Abstract

Despite the clinical and financial implications, there is little evidence about how patients who have been treated for soft tissue sarcoma should be followed up. The purpose of this study was to determine current practice in the United Kingdom. 192 clinicians treating patients with soft tissue sarcoma were surveyed with a postal questionnaire enquiring about frequency and method of follow up and how patients would be followed up in each of 3 clinical scenarios: a patient with a trunk or extremity tumour at low risk of relapse; a patient with a trunk or extremity tumour at high risk of relapse; and a patient with a retroperitoneal or abdominal tumour. 155 (81%) clinicians responded. Clinic visits and X-rays were the most frequently used methods of follow up. Chest CT scans, local site imaging, and blood tests were used infrequently. The intensity and methods of follow up varied with each of the clinical scenarios. There was a seven-to-twenty fold variation in cost between the least and the most expensive regimes. Respondents were generally supportive of the development of the clinical trial in this area.

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

“…Although the importance of following patients with sarcoma is widely accepted, frequent surveillance is time-consuming for both patients and physicians, increases healthcare expenditures [11,21,22], and, with respect to the use of CT scans, exposes patients to ionizing radiation [4]. Furthermore, limited evidence exists to support the intervals, modalities, or duration of monitoring [3,9,11].…”

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

“…With improved patient survival, followup surveillance strategies are becoming increasingly important with considerable clinical and fiscal implications. However, the ideal postoperative protocol, particularly the frequency of followup and appropriate screening modalities for these uncommon neoplasms, remains ill defined [8,10,18]. Current guidelines are not based on high-quality evidence [10,18].…”

“…Current guidelines are not based on high-quality evidence [10,18]. Current postoperative surveillance regimes are empirical and vary widely from center to center [8,9,18]. Even consensus guidelines lack definite recommendations [20].…”

“…Routine postoperative followup in most high-volume centers includes a rather intensive regime both in terms of frequency and the modality of screening for recurrent disease. Whether an increased frequency of followup visits and the use of various expensive imaging modalities for screening and early detection of recurrence actually result in improving overall survival of patients with extremity sarcomas is a question that remains as yet unanswered [8]. The additional radiation exposure to the patient resulting from repeated imaging undertaken for surveillance is also a matter of concern [2].…”

“…In an increasingly ''costconscious'' healthcare scenario, allocation of limited health funding is best guided by evidence-based recommendations rather than empirical beliefs [18,19]. A well-designed prospective trial to evaluate the impact of followup strategies on disease outcomes would help develop an evidence-based surveillance schedule [1,8,9].…”