Oncological surgery follow-up and quality of life: meta-analysis

• Published in: British journal of surgery Vol. 110; no. 6; pp. 655 - 665
• Main Authors: Wullaert, Lissa, Voigt, Kelly R, Verhoef, Cornelis, Husson, Olga, Grünhagen, Dirk J
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.06.2023
• Subjects: Anxiety; Follow-Up Studies; Humans; Male; Neoplasms - surgery; Quality of Life; Systematic Review
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1093/bjs/znad022

Abstract Background Previous trials found that more intensive postoperative surveillance schedules did not improve survival. Oncological follow-up also provides an opportunity to address psychological issues (for example anxiety, depression, and fear of recurrence). This systematic review assessed the impact of a less intensive surveillance strategy on health-related quality of life (HRQoL), emotional well-being, and patient satisfaction. Methods A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, Cochrane database, PsycINFO, and Google Scholar to identify studies comparing different follow-up strategies after oncological surgery and their effect on HRQoL and patient satisfaction, published before 4 May 2022. A meta-analysis was conducted on the most relevant European Organisation for Research and Treatment of Cancer QLQ-C30 and Hospital Anxiety and Depression Scale subscales. Results Thirty-five studies were identified, focusing on melanoma (4), colorectal (10), breast (7), prostate (4), upper gastrointestinal (4), gynaecological (3), lung (2), and head and neck (1) cancers. Twenty-two studies were considered to have a low risk of bias, of which 14 showed no significant difference in HRQoL between follow-up approaches. Five studies with a low risk of bias showed improved HRQoL or emotional well-being with a less intensive follow-up approach and three with an intensive approach. Meta-analysis of HRQoL outcomes revealed no negative effects for patients receiving less intensive follow-up. Conclusion Low-intensity follow-up does not diminish HRQoL, emotional well-being, or patient satisfaction. The results of this review suggest that a lower-intensity follow-up approach is non-inferior and, in some instances, even results in slightly better health-related quality of life (HRQoL) and lower anxiety rates. Additionally, previous studies and a recently published systematic review failed to show any (cancer-specific) survival benefit of intensive postoperative surveillance compared with a less intensive approach. Overall, these findings enable a reduction in follow-up intensity for patients with cancer without impact on the main purposes of follow-up: cancer-specific survival and HRQoL. It can be concluded that a patient-tailored follow-up approach is feasible.