Abstract
Purpose: To examine the costs and benefits of an established practice of routine follow-up in a cohort of patients treated with radiation therapy for early stage Hodgkin's disease. Materials and Methods: We retrospectively examined patterns of follow-up and methods of relapse detection among 709 patients with Ann Arbor Stage I-II Hodgkin's disease treated with sub-total lymphoid irradiation (STLI) or total lymphoid irradiation (TLI) between 1969-1994. We determined the probability of relapse detection for each of 7 routine follow up procedures, compared their relative costs, and determined the impact of each procedure on the likelihood of overall survival following salvage therapy. Results: Relapse has occurred in 157 patients (22%) at a median 1.9 years (range 0-13 years) following treatment. 133 relapses (85%) occurred during the first 5 years of follow. Detailed information concerning the method of relapse detection was available on 107 patients. These 107 patients form the basis of this analysis. Relapse was identified by history (Hx) alone in 55% of patients, physical exam (PE) in 14%, chest x-ray (CXR) in 23% and abdominal x-ray (KUB) in 7%. Only one relapse (1%) was identified by a routine laboratory study - erythrocyte sedimentation rate (ESR). The rate of relapse detection was
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Citation Formats
Torrey, Margaret J, Poen, Joseph C, and Hoppe, Richard T.
Detection of relapse in early stage Hodgkin's disease: role of routine follow up studies.
United States: N. p.,
1995.
Web.
doi:10.1016/0360-3016(95)97808-E.
Torrey, Margaret J, Poen, Joseph C, & Hoppe, Richard T.
Detection of relapse in early stage Hodgkin's disease: role of routine follow up studies.
United States.
https://doi.org/10.1016/0360-3016(95)97808-E
Torrey, Margaret J, Poen, Joseph C, and Hoppe, Richard T.
1995.
"Detection of relapse in early stage Hodgkin's disease: role of routine follow up studies."
United States.
https://doi.org/10.1016/0360-3016(95)97808-E.
@misc{etde_20420664,
title = {Detection of relapse in early stage Hodgkin's disease: role of routine follow up studies}
author = {Torrey, Margaret J, Poen, Joseph C, and Hoppe, Richard T}
abstractNote = {Purpose: To examine the costs and benefits of an established practice of routine follow-up in a cohort of patients treated with radiation therapy for early stage Hodgkin's disease. Materials and Methods: We retrospectively examined patterns of follow-up and methods of relapse detection among 709 patients with Ann Arbor Stage I-II Hodgkin's disease treated with sub-total lymphoid irradiation (STLI) or total lymphoid irradiation (TLI) between 1969-1994. We determined the probability of relapse detection for each of 7 routine follow up procedures, compared their relative costs, and determined the impact of each procedure on the likelihood of overall survival following salvage therapy. Results: Relapse has occurred in 157 patients (22%) at a median 1.9 years (range 0-13 years) following treatment. 133 relapses (85%) occurred during the first 5 years of follow. Detailed information concerning the method of relapse detection was available on 107 patients. These 107 patients form the basis of this analysis. Relapse was identified by history (Hx) alone in 55% of patients, physical exam (PE) in 14%, chest x-ray (CXR) in 23% and abdominal x-ray (KUB) in 7%. Only one relapse (1%) was identified by a routine laboratory study - erythrocyte sedimentation rate (ESR). The rate of relapse detection was highest for a combination of history and physical exam (78/10,000 exams) followed by CXR (26/10,000 exams), KUB (10/10,000 exams) and ESR (1/10,000 tests). Complete blood count (CBC) and serum chemistries were never the primary factor in detecting HD relapse. Radiographs accounted for greater than 60% of charges while laboratory studies and physician charges accounted for approximately 20% each. The projected charges (1994 dollars) of relapse detection by routine follow up Hx and PE was [dollar]10,600 compared with [dollar]68,200 for CXR, [dollar]141,800 for KUB and [dollar]156,400 for ESR. 10 year actuarial survival following salvage therapy was 65% overall, 65% for patients in whom relapse was detected by Hx or PE and 69% for patients in whom relapse was detected by radiographs (p = N.S.). Conclusions: The majority of relapses occurred within 5 years of treatment and were identified by Hx and PE. Chest x-ray was a useful screening study during the first three years of follow up. KUB, CBC, serum chemistries and ESR account for nearly half of all follow-up charges and rarely detect relapse. Their routine use as a method of relapse detection is questionable. In general, the method of relapse detection did not significantly impact upon the likelihood of successful salvage therapy.}
doi = {10.1016/0360-3016(95)97808-E}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}
title = {Detection of relapse in early stage Hodgkin's disease: role of routine follow up studies}
author = {Torrey, Margaret J, Poen, Joseph C, and Hoppe, Richard T}
abstractNote = {Purpose: To examine the costs and benefits of an established practice of routine follow-up in a cohort of patients treated with radiation therapy for early stage Hodgkin's disease. Materials and Methods: We retrospectively examined patterns of follow-up and methods of relapse detection among 709 patients with Ann Arbor Stage I-II Hodgkin's disease treated with sub-total lymphoid irradiation (STLI) or total lymphoid irradiation (TLI) between 1969-1994. We determined the probability of relapse detection for each of 7 routine follow up procedures, compared their relative costs, and determined the impact of each procedure on the likelihood of overall survival following salvage therapy. Results: Relapse has occurred in 157 patients (22%) at a median 1.9 years (range 0-13 years) following treatment. 133 relapses (85%) occurred during the first 5 years of follow. Detailed information concerning the method of relapse detection was available on 107 patients. These 107 patients form the basis of this analysis. Relapse was identified by history (Hx) alone in 55% of patients, physical exam (PE) in 14%, chest x-ray (CXR) in 23% and abdominal x-ray (KUB) in 7%. Only one relapse (1%) was identified by a routine laboratory study - erythrocyte sedimentation rate (ESR). The rate of relapse detection was highest for a combination of history and physical exam (78/10,000 exams) followed by CXR (26/10,000 exams), KUB (10/10,000 exams) and ESR (1/10,000 tests). Complete blood count (CBC) and serum chemistries were never the primary factor in detecting HD relapse. Radiographs accounted for greater than 60% of charges while laboratory studies and physician charges accounted for approximately 20% each. The projected charges (1994 dollars) of relapse detection by routine follow up Hx and PE was [dollar]10,600 compared with [dollar]68,200 for CXR, [dollar]141,800 for KUB and [dollar]156,400 for ESR. 10 year actuarial survival following salvage therapy was 65% overall, 65% for patients in whom relapse was detected by Hx or PE and 69% for patients in whom relapse was detected by radiographs (p = N.S.). Conclusions: The majority of relapses occurred within 5 years of treatment and were identified by Hx and PE. Chest x-ray was a useful screening study during the first three years of follow up. KUB, CBC, serum chemistries and ESR account for nearly half of all follow-up charges and rarely detect relapse. Their routine use as a method of relapse detection is questionable. In general, the method of relapse detection did not significantly impact upon the likelihood of successful salvage therapy.}
doi = {10.1016/0360-3016(95)97808-E}
journal = []
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}