Evidence-based follow-up of lung cancer patients.

Evidence-based follow-up care of the lung cancer patient is straightforward with periodic histories and physical examinations recommended to detect recurrence. Yearly chest radiographs to detect second primaries "may be reasonable" in small and non-small cell lung cancer patients. The routine use of computed axial tomography (CAT) scans, bone scans, brain imaging, and serum tumor markers is not recommended in lung cancer patients. Many patients receive more extensive and expensive follow-up after treatment, despite the lack of curative options for recurrent lung cancer or evidence that earlier treatment of recurrence leads to better medical outcomes. The reasons for this are not known at present but could involve patient or physician preference, with no disincentives for extra testing. Adherence to breast cancer follow-up clinical practice guidelines at one cancer center reduced cost by one third with no change in health outcomes, but no studies have been performed in lung cancer.