The COVID-19 pandemic has given new relevance to the way in which cancer patients are followed up. There are good reasons for making the changes that are now being introduced permanent.
The COVID-19 pandemic has spurred the Norwegian oncological community to establish rules for prioritising the treatment of cancer patients. The doctors must also prioritise those patients who need outpatient follow-up and the procedures for monitoring them. This serves to draw attention to a problem, namely the fact that many patients are monitored for unnecessarily long periods and not necessarily in the right way. In our opinion, we should make use of this crisis to improve our follow-up, so as to spend health resources on the right patients.
More expensive cancer drugs and more cancer survivors are already challenging strained hospital budgets. The follow-up after completed cancer therapy is based on tradition more than on evidence (1–3). According to a recently published Cochrane review, neither the frequency of check-ups, nor the doctor's level of specialisation had any effect on cancer survival or the participants' quality of life (4).
In a review of patient lists, the doctors in our departments have identified many patients who do not need to continue the current follow-up programme
We can use gynaecological cancer as an example. These types of cancer are normally diagnosed at an early stage, and recurrence is rare (5). In cases of more advanced disease, recurrences most often manifest themselves within 2–3 years (6). Despite wide differences in the risk of recurrence and sequelae, most patients are nevertheless followed up for five years or more. Why are we perpetuating this practice? It makes most patients feel safe, and many believe that recurrences are discovered at the routine check-up (7). The fact is, however, that recurrences most often produce symptoms that can occur in the intervals between the check-ups (6). In spite of this, many patients fail to contact their doctor (6, 8). Instead, they wait for the next check-up appointment, which may affect the treatment and thereby also the prognosis (6). For the doctors, this is an established habit and how they have been accustomed to follow up their patients. Moreover, the national guidelines recommend following up cancer patients over many years, irrespective of their prognosis (9).