Patient Surveillance After Cancer Treatment

Patient Surveillance After Cancer Treatment

Patient Surveillance After Cancer Treatment covers the history of cancer patient surveillance after curative-intent treatment, the rationale, the methodologies used in the past and at present, the methodologies that will probably emerge in the future, the costs of surveillance, the definitions of various terms used in the field, and how those who are interested in the topic can get more information about it from the internet. The secondary focus of the book is to publicize the need for well-designed, adequately powered randomized clinical trials comparing two (or more) surveillance strategies for each type of cancer.

The audience includes all oncologists, cancer researchers, medical economists and policy makers in government and insurance companies, and finally, interested patients.

This book is part of the Current Clinical Oncology series, which provides cutting-edge knowledge of cancer diagnosis, management, and treatment. World renowned experts share their insights in all the major fields of clinical oncology. From the fundamentals of pathophysiology to the latest developments in experimental and novel therapies, Current Clinical Oncology is an indispensable resource for today’s practicing oncologist.

Cancer remains a major cause of death worldwide. With modern therapy, millions of patients can expect (or at least hope) to be cured. With the passage of time, a proportion of these cancer survivors experience recurrence. Some die and some are rescued by further interventions. Some sustain complications of treatment which are merely annoying; others are fatal. These considerations show that cancer patient care is an important topic, but it is presently underresearched and underappreciated. The primary focus of this book is patient surveillance after curative-intent initial treatment. It is my second book devoted to this topic. The format is somewhat different from the first (Cancer Patient Follow-up, Mosby, 1997). The secondary focus of the book is to publicize the need for well-designed, adequately powered randomized clinical trials comparing two (or more) surveillance strategies for each type of cancer. Currently the National Institutes of Health and other major sources of funding in America do sponsor 
research about the clinical course of cancer patients after treatment but do not support such trials. Clinicians, patients, and society as a whole are harmed by this. Clinicians lack highquality evidence upon which to base surveillance for their patients. Patients are subjected to diagnostic tests that are utilized at remarkably different rates, even by expert physicians. This is prima facie evidence of overuse and/or underuse of resources, with signi fi cant risk of misuse as well. In order to rationalize surveillance, we believe that patients, physicians, the public health community, advocacy groups, payers, and others will need to advocate for enabling legislation that requires such trials. The Medical Research Council of the United Kingdom and similar agencies in other European countries have already accepted this premise, and the trial results have changed medical practice. Such trials are expensive. They typically take years to accrue a suf fi cient number of patients, and several more years to mature and yield results. Successor trials will be required as new salvage therapies enter clinical practice, better methods of prevention and early detection are devised, toxic effects of therapy are avoided or mitigated, and so on.

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