Detecting lung cancer relapse using self-evaluation forms weekly filled at home: the sentinel follow-up
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We aimed to assess if patients' ratings of symptoms can be used to provide an early indication of disease recurrence or progression in lung cancer. We proposed a simple self-evaluation form made of six clinical parameters weekly scored by patients at home as a follow-up—here named sentinel—to improve relapse detection. Its performances were compared to those of a routine imaging follow-up.
Patients with lung cancer were prospectively recruited to weekly fill a form at home for self-assessing weight, fatigue, pain, appetite, cough, and breathlessness during at least 4 months. Each patient reported weight and assessed the severity of each symptom by grading it from 0 (no symptom) to 3 (major symptom). A score was retrospectively designed for discriminating patients with relapse from those without. Accuracy of relapse detection was then compared to values of the routine planned imaging.
Forty-three patients were included in our center and recruited for 16 weeks or more follow-up during which at least one tumor imaging assessment was performed (CT scan or PET-CT). Forty-one completed the form weekly. Sensitivity, specificity, and positive and negative predictive values of sentinel were high (86, 93, 86 % and 93 vs 79, 96, 92, and 90 % for routine imaging—p = ns) and well correlated with relapse (pχ2 > 0.001). Moreover, relapses were detectable with sentinel on average 6 weeks earlier than the planned imaging.
This study suggests that a personalized cancer follow-up based on a weekly self-evaluation of six symptoms is feasible and may be accurate for earlier detection of lung cancer relapse, allowing integration in electronic devices for real-time patient outcome follow-up.
KeywordsLung cancer Follow-up Supportive care Personalized medicine Early relapse detection
Conflicts of interest
There are no financial disclosures, conflicts of interest, for the authors, and no funding sources for the manuscript.
- 1.French National Institute report (2013) Survival of patients with cancer 1989 – 2007Google Scholar
- 2.Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, et al. (eds) (2012) SEER Cancer Statistics Review, 1975–2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD. Based on November 2011 SEER data submission, posted to the SEER web site, April 2012. Available: http://seer.cancer.gov/csr/1975_2009_pops09/. Accessed 09 January 2012
- 4.Crino L, Weder W, van Meerbeeck J, Felip E (2010) On behalf of the ESMO guidelines working group. Early stage and locally advanced (non-metastatic) non-small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v103–v115PubMedCrossRefGoogle Scholar
- 5.Van Loon J, Grutters J, Wanders R et al (2009) Follow-up with 18FDG-PET-CT-CT after radical radiotherapy with or without chemotherapy allows the detection of potentially curable progressive disease in non-small cell lung cancer patients: a prospective study. Eur J Cancer 45:588–595PubMedCrossRefGoogle Scholar
- 19.NCCN Guidelines™ Version 1.2012 Non-Small Cell Lung CancerGoogle Scholar