Cost effectiveness in the post‐treatment follow‐up of cancer patients

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Abstract
The provision of a beneficial follow‐up system at a realistic cost within a fixed budget became a subject of investigation at the Ellis Fischel State Cancer Hospital (EFSCH) when, in 1961, the number of patients to be seen exceeded the capacity of the staff and facilities to accommodate them. The interval recurrence rate for different categories of cancer not cured by primary therapy was determined and used to evaluate the frequency and methods of post‐treatment follow‐up examination. Disparities were found between the interval recurrence rates and the follow‐up schedule used prior to 1961. A series of clinical management studies was conducted to review the prognostic indicators that increased the likelihood for control with primary treatment and for the development of recurrence, the value of clinical laboratory and roentgen evaluations in diagnosing recurrences, the efficacy of retreatment, the development of additional neoplasms in the same host, and the number of years of productive life added to a population as a result of follow‐up. A site‐specific follow‐up schedule was developed by integrating the periods of risk to develop treatable recurrences with staff, budget, and facilities available. Because of age, low probability of recrudescence of the original neoplasm, and the fact that most persons who have had one cancer treated are at no greater risk to develop additional cancers than the general population of the same age, many EFSCH patients are now returned to community follow‐up after 10 years. The sites having multiple cancers with a frequency greater than could be predicted on the basis of known incidence rates have been identified.