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Follow-up of patients with Hodgkin's disease following curative treatment: the routine CT scan is of little value

Authors
Publisher
Nature Publishing Group
Publication Date
Identifiers
DOI: 10.1038/sj.bjc.6601052
Keywords
  • Clinical
Disciplines
  • Medicine

Abstract

Follow-up of patients with Hodgkin’s disease following curative treatment: the routine CT scan is of little value ET Dryver1, H Jernstro¨m2, K Tompkins1,3, R Buckstein1,3,4 and KR Imrie*,1,3,4 1The University of Toronto, Toronto, Ontario, Canada M5S 1A1; 2The Jubileum Institute, Department of Oncology, Lund University Hospital, S-22185 Lund, Sweden; 3Toronto Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5; 4Sunnybrook & Women’s College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5 A total of 10–40% of patients with Hodgkin’s disease relapse following initial curative therapy. Intensive follow-up is resource intensive and may identify false relapses. We performed a retrospective review of all patients with Hodgkin’s disease treated at our centre between 1990 and 1999 to evaluate the utility of the components of follow-up. A total of 107 patients met the inclusion and exclusion criteria. The median age was 33 years and the median duration of follow-up 38 months. The total number of follow-up visits was 1209 and total number of CT scans 283. There were 109 suspected relapses of which 22 proved to be true relapses. Of the latter, 14 were identified clinically, six radiologically and two via lab testing. The routine CT scan detected only two relapses (9%), yet accounted for 29% of the total follow-up costs. Based on data from our centre, the cost per true relapse was $6000 US, 49% incurred by radiological tests. The majority of the cost of follow-up was incurred by routine follow-up (84%) as opposed to the investigation of suspected relapses (16%). We conclude that most true relapses are clinically symptomatic and that the routine CT is an expensive and inefficient mode of routine follow-up. British Journal of Cancer (2003) 89, 482–486. doi:10.1038/sj.bjc.6601052 www.bjcancer.com & 2003 Cancer Research UK Keywords: Hodgkin’s disease; follow-up; relapse; computed tomography scan � � � � � � � � � � � � � � � � � � � �

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