4267 What is the best way to follow-up lung cancer patients? Findings from a systematic review and the development of a new model of care

Abstract

Background: The burden of illness is high for lung cancer patients, carers and society. Follow-up interventions may be able to support patients living with lung cancer and improve survival. The aim of this review was to examine the evidence for the effectiveness of intensive follow-up of patients with lung cancer. This review is the first step in the development of a new model of service delivery for lung cancer patients utilising the Medical Research Council (UK) guidance for the development of complex interventions. Material and Methods: Data sources: English language observational studies and randomised clinical trials (RCTs) were retrieved from electronic databases (Ovid Medline, Embase, PsychINFO, CINAHL, British Nursing Index, Cochrane Library and National Research Register). If there was more than one study with like populations, interventions and outcomes, the relevant data were statistically synthesised. Time to event data were synthesised using hazard ratios (HR) and 95% confidence intervals. Results: Nine studies that examined the role of intensive follow-up for lung cancer patients were included in the review (eight observational studies and one RCT). This meta-analysis shows that there is a trend for intensive follow-up to improve survival in patients with lung cancer, although this result is not statistically significant for the curative treatment intent group (HR 0.82, CI 0.64−1.05) or the palliative treatment group (HR 0.69, CI 0.46−1.04). There is a statistically significant difference in survival for patients with potentially resectable NSCLC with asymptomatic recurrence (HR 0.59, CI 0.48−0.72), although this is complicated by lead time bias. Conclusion: There is no evidence that intensive follow-up of lung cancer patients improves survival compared to standard or less intensive follow-up. However, because this finding is based on observational studies with potential for bias, further evidence, ideally from RCTs, is needed. The review identified limited reporting of patient centered outcomes. Further research is required to explore patient-centered outcomes of follow-up such as quality of life and satisfaction. The second phase of this research is underway exploring patients', professionals' and carers' views of follow-up care to develop an intervention that can be tested in a clinical trial. The findings of this review will be discussed in the context of this ongoing research and the development of a new nurse led intervention for the follow-up of lung cancer patients.