Data from 12 previously published studies involving 849 patients
show that after completing treatment, patients want as many
follow-up exams and tests as possible to reassure them that tumors
have not returned, researchers found.
“Patients want intensive follow-up which comprises a lot of
testing,” said senior study author Geertruida de Bock, of the
University of Groningen in the Netherlands.
“Though this is understandable, it is not desirable since care for
cancer is already under pressure due to rising numbers of
survivors,” de Bock said by email.
Worldwide, an estimated 33 million people are cancer survivors.
Their ranks are expected to grow due to rising cancer rates in an
aging population as well as improved survival odds with advances in
diagnosis and treatment.
As cancer increasingly becomes a chronic disease instead of a death
sentence, doctors and patients are struggling to strike the right
balance between doing enough follow-up tests to catch any new tumors
quickly and avoiding too many needless tests that can lead to
unnecessary interventions that don’t help people live longer.
Cancer survivors typically get care focused on monitoring for the
return of tumors or the development of malignancies in other parts
of the body. This can include invasive tests like biopsies as well
as expensive imaging like positron emission tomographic (PET)
Guidelines for follow-up tests depend on many factors including the
type of cancer, how advanced it was when it was first detected and
treated, and individual patient characteristics like age and other
While the current analysis didn’t examine the outcomes of giving
cancer survivors too many or too few tests, it offers fresh evidence
that patients may often want more testing than doctors should do
based on current treatment guidelines.
For example, some patients said the process of getting more tests
and waiting for the results made them anxious, but some patients
also said they wanted to continue with a lifetime of extensive
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Patients often said they had lost confidence in their body and
feared recurrence so much that they requested screenings that they
understood might not be needed. They also expressed a desire for
mental health care and psychological support.
The study wasn’t a controlled experiment designed to test how or if
patients’ preferences about follow-up care influence treatment for
Even so, the findings suggest that doctors and patients may need to
have more-frank conversations about how follow-up tests can help and
when extensive testing may do more harm than good.
Patients should understand how many recurrent cancers are typically
detected with a specific test and how often they might get what’s
known as a false-positive result, when the test result suggests that
tumors have returned even though that’s not the case, de Bock said.
False negatives, when people with new tumors think they’re
cancer-free, are also possible.
“Intensive surveillance can lead to false-positive results and to
unnecessary tests and potentially harmful biopsies of suspicious
lesions seen on body imaging,” said Dr. Carlos Barcenas, of the
University of Texas MD Anderson Cancer Center in Houston. “In
addition, a false-negative result of a test may also give a false
reassurance to a patient.”
“Patients and doctors should clearly discuss the surveillance plan
after active treatments have finished and clarify expectations,”
said Barcenas, who wasn’t involved in the study.
SOURCE: http://bit.ly/2vWEq8b Maturitas, online July 5, 2017.
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