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Follow-up care after treatment of lung cancer

To discover recurrence of the disease or a new primary tumor, checks should be carried out every three to six months for the first two years, thereafter annually. Follow-up regarding complications should be done by a thoracic surgeon, lung specialist, or oncologist in one to three months after treatment.

Examination should include: 

  • patient history
  • clinical examination
  • image analysis (chest X-ray, more rarely chest CT scan)
  • blood tests

These checks can be completed at a local hospital, possibly in dialog with the patient's primary doctor. Patients should be informed of possible symptoms and encouraged to contact the hospital if they develop new symptoms or a worsening of pre-existing symptoms.  

Routine PET scans do not have any documented role in patient follow-up at the present time. Tumor markers such as CEA, NSE or proGRP are only of value if they were elevated before starting treatment. 

At the time of diagnosis, about sixty percent of patients smoke while forty percent of these have stopped two years after the diagnosis. Smoking cessation at the time of the diagnosis reduces the risk for developing metachronous tumors. Potentially cured lung cancer patients who smoke are highly encouraged to stop smoking.

Complications after curative treatment 

The most common complications after a lung resection are loss of lung function and chronic pain.

Complications from radiation therapy can affect the lungs, skin, esophagus, or muscles. More rare complications are damage to the pericardium and heart. Acute radiation pneumonitis can often be treated successfully with steroids. However, delayed radiation pneumonitis often represents irreversible lung damage, but is rarely seen.  

Most side effects of chemotherapy occur during treatment. An exception is peripheral neuropathy from vinca alkaloids or taxanes. 

Recurrence or development of a new primary tumor after curative treatment

Recurrence is frequent. Even with stage I cancer, five year recurrence rates up to thirty-nine percent are reported. Most recurrences occur within four years after treatment.

For small cell lung cancer, a new tumor occurring more than two years after primary treatment will often be a new primary tumor as most recurrences occur within a short period after initial treatment.

Palliative treatment

For the patient's feeling of security and ensuring a good palliative treatment, it is important to provide relatively frequent follow-up.

Due to the greater need for treatment to relieve symptoms, it may be necessary to request the patient to be checked every three months for the first year and then to increase the intervals. Resource-demanding examinations should be avoided except for work-up of new symptoms or clinical findings. 
 

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