How tumor stage affects surgeons' surveillance strategies after surgery for carcinoma of the upper aerodigestive tract

BACKGROUND. The factors that influence decision-making among surgeons are not well understood. The authors evaluated how tumor stage in otherwise healthy patients subjected to potentially curative surgery for upper aerodigestive tract (UADT) epidermoid carcinoma affects the self-reported follow-up strategies employed by practicing surgeons. METHODS. Hypothetical patient profiles and a detailed questionnaire based on these profiles were mailed to the 824 members of the Society of Head and Neck Surgeons (SHNS) and the 522 members of the American Society for Head and Neck Surgery who were not members of SHNS. The effect of TNM stage on the surveillance strategies chosen by the respondents was analyzed. RESULTS. Ten of the 14 most commonly employed surveillance modalities were ordered significantly more frequently with increasing TNM stage. This effect persisted through 5 years of follow- up, but the differences across stages were small. Only 30% of respondents modified their strategies according to the patient's TNM stage. CONCLUSIONS. Most surgeons performing surveillance after potentially curative surgery in otherwise healthy patients with UADT carcinoma use the same follow-up strategy irrespective of TNM stage. These data permit rational design of a randomized clinical trial of two alternate follow-up plans.