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Practice Patterns and Clinical Guidelines for Posttreatment Follow-up of Head and Neck Cancers
A Comparison of 2 Professional Societies
Randal C. Paniello, MD;
Katherine S. Virgo, PhD;
Michael H. Johnson;
Marc F. Clemente, MD;
Frank E. Johnson, MD
Arch Otolaryngol Head Neck Surg. 1999;125:309-313.
Objectives To determine and compare the current follow-up practice patterns of members of 2 professional societies of head and neck surgeons, and to compare these with the societies' published clinical practice guidelines.
Design A survey was mailed to the 640 members of the American Society for Head and Neck Surgery (ASHNS); results were compared with those of a similar survey of the 824 members of the Society of Head and Neck Surgery (SHNS) and with the clinical practice guidelines of the consensus committee of both societies.
Main Outcome Measures Data were collected regarding the frequency of follow-up visits after potentially curative resection of head and neck epidermoid carcinoma and the types of diagnostic studies performed at each visit.
Results A total of 318 ASHNS members responded to 1 of the mailings (49.7%), of which 280 responses (43.8%) were evaluable. Most surgeons relied on directed history, physical examination, and routine chest radiograph at varying intervals for detection of recurrences and second primary tumors. Other tests were used sporadically. For frequency of follow-up testing, the percentage of surgeons who followed the published guidelines varied from 97% in postoperative year 1 to 62% in postoperative year 5. A mean of 24% of surgeons varied from the guidelines in their use of chest radiographs, and 45% varied in their use of liver function tests. The ASHNS members used significantly more office visits than the SHNS members during the first 2 postoperative years.
Conclusions The strategies used by members of the ASHNS and the SHNS for posttreatment surveillance after potentially curative resection of malignant neoplasms of the head and neck were generally similar but showed some important differences. Most surgeons used directed history and physical examination at regular intervals, and annual chest radiographs. The follow-up practices of most members of these societies, which have recently merged, fall within the recommendations of the Clinical Guidelines Task Force.
From the Department of Otolaryngology, Washington University School of Medicine (Dr Paniello); Department of Surgery, St Louis University School of Medicine (Drs Virgo, Clemente, and Johnson); and Surgery Service, Department of Veterans Affairs Medical Center (Drs Paniello, Virgo, and Johnson and Mr Johnson), St Louis, Mo.
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