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Original Investigation
From the American Head and Neck Society
September 3, 2020

Outcomes of a Telephone-Based Questionnaire for Follow-up of Patients Who Have Completed Curative-Intent Treatment for Oral Cancers

Author Affiliations
  • 1Department of Head & Neck Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
  • 2Department of Otorhinolaryngology–Head Neck Surgery, Imperial College Healthcare NHS, London, United Kingdom
  • 3Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
  • 4Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
JAMA Otolaryngol Head Neck Surg. Published online September 3, 2020. doi:10.1001/jamaoto.2020.2404
Key Points

Question  What is the role of a symptom-based telephone questionnaire in detecting recurrences in patients with radically treated oral cancer?

Findings  In this diagnostic cohort study of 400 patients with oral cancer, a symptom-based questionnaire was found to have a sensitivity of 90% and a negative predictive value of 99% for detecting cancer recurrences.

Meaning  This questionnaire may help in identifying patients at higher risk of cancer recurrence; furthermore, the questionnaire may help avoid overcrowding in clinics, enhance proper utilization of health care resources, and deter unnecessary clinic visits for patients.

Abstract

Importance  Follow-up assessment of patients who had treatment for head and neck cancer is critical and an important part of the overall treatment program. During each visit to the hospital, patients are evaluated by a physician and may undergo additional tests. Because it has been observed that the symptoms mentioned by patients often guide the treating clinicians in identifying cancer recurrence, an appropriately constructed questionnaire can help clinicians determine which patients need further testing as a result of a recurrence and which patients can continue to be monitored remotely.

Objective  To evaluate the role of a symptom-based telephone questionnaire in detecting recurrences in patients with radically treated oral cancer.

Design, Setting, and Participants  This prospective diagnostic cohort study was conducted from October 1, 2018, to February 28, 2019. This study took place at Tata Memorial Centre, an apex referral cancer center in India. A total of 615 consecutive patients with oral cancer were screened, of whom 400 patients consented to be a part of the study. After completion of curative treatment, these patients were followed up for 2 months to 2 years. We excluded patients younger than 18 years or older than 80 years, those with Eastern Cooperative Oncology Group status greater than 2, and those who had already been diagnosed with recurrent disease.

Interventions/Exposures  The patients were contacted 2 weeks before their clinic appointment, and a telephone interview was conducted using a predefined questionnaire. Based on patients’ responses to these questions, their disease status was estimated. Subsequently, during the actual follow-up visit, a trained head and neck surgeon, who was blinded to the questionnaire result, examined them.

Main Outcomes and Measures  The sensitivity and specificity of the telephone questionnaire were calculated by comparing its results with those of the trained head and neck surgeon after the clinical evaluation.

Results  Of the 615 patients screened, 400 consented to be part of the study. Participants had a median (interquartile range) age of 49 (41-56) years, and 334 (83.5%) were men. Recurrence was noted in 20 patients (5.0%). The telephone-based questionnaire was found to have sensitivity of 90.0%, specificity of 74.2%, positive predictive value of 15.5%, and negative predictive value of 99.3%. Clinical examination values were 100.0%, 92.9%, 42.5%, and 100.0%, respectively. A total of 124 patients (31.0%) said that they would prefer such a telephone follow-up compared with an actual physical follow-up visit.

Conclusions and Relevance  This diagnostic cohort study found that a symptom-based telephone questionnaire had good sensitivity and negative predictive value for detecting recurrences in patients with oral cancer on follow-up evaluation after completion of definitive treatment.

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