Commentary: Channeling Goldilocks

Central MessageThoracic surgeons should weigh several considerations, including patient preferences, when making recommendations for imaging surveillance after lung cancer resection.See Article page 680. Thoracic resection. See In this Invited Expert Opinion piece, Heiden and colleagues1Heiden B.T. SMP Puri V. Kozower B.D. Striking a balance: of non–small cell resection.J Thorac Cardiovasc Surg. 2021; 162: 680-684Abstract Full Text PDF Scopus (3) Google Scholar discuss the evidence following resection treatment. It is somewhat surprising that there such low-level routine even more rate guideline concordance “appropriate” in patients with resected paltry 61%.2Erb C.T. Su K.W. Soulos P.R. Tanoue L.T. Gross C.P. Surveillance practice patterns curative intent therapy stage I non–small-cell Medicare population.Lung Cancer. 2016; 99: 200-207Abstract PubMed (16) The authors provide sound rationale using computed tomography (either diagnostic or low-dose variants), rather than plain chest radiograph and/or positron emission scan. There are few other concepts, however, warrant consideration. First, we must make conscious decision to differentiate between screening cancer. population at risk both recurrence AND second primary, latter becoming important approximately 2 years treatment, as noted by authors. However, because their history increased relative patients, those previously treated not be considered within confines population. fact, American College Radiology dropped “C” modifier previous introduction Lung-RADS 1.1. change “patients diagnosed usually have annual CTs disease surveillance—which same screening.”3ACR - Update 1.1.https://www.acr.org/-/media/ACR/Files/RADS/Lung-RADS/LungRADS-1-1-updates.pdfDate: 2019Date accessed: November 10, 2020Google absence strong regarding interval long-term outcomes cancer, perhaps also consider incorporating preferences help guide intervals our patients. recent study thyroid classified “strong maximizers” had significantly doctors' visits studies related malignancy compared “minimizers.”4Evron J.M. Reyes-Gastelum D. Banerjee M. Scherer L.D. Wallner L.P. Hamilton A.S. et al.Role maximizing-minimizing surveillance.J Clin Oncol. 2019; 37: 3042-3049Crossref We do what can minimize distress surveillance. “Scanxiety,” scan-associated distress, has been reported 80% significant deleterious impact on quality life.5Bauml Troxel A. Epperson C.N. Cohen R.B. Schmitz K. Stricker C. al.Scan-associated cancer: quantifying “scanxiety”.Lung 100: 110-113Abstract (41) While cannot completely eliminate less- frequent who “minimizers” might reasonable. Finally, landscape systemic treatment changed dramatically over last 10 years, already positive survival.6Howlader N. Forjaz G. Mooradian M.J. Meza R. Kong C.Y. Cronin K.A. al.The effect advances lung-cancer mortality.N Engl J Med. 2020; 383: 640-649Crossref (260) As illustrated results PACIFIC ADAURA trials, use targeted therapies specific populations resulted prolonged disease-free overall survival.7Antonia S.J. Villegas Daniel Vicente Murakami S. Hui al.Durvalumab chemoradiotherapy III cancer.N 2017; 377: 1919-1929Crossref (2052) Scholar,8Wu Y.L. Tsuboi He J. John T. Grohe Majem al.Osimertinib EGFR-mutated 1711-1723Crossref (314) number options treating recurrent continue grow, only treat if (look and) find it. Goldilocks did story Three Bears, appropriate each individual his her circumstance—one too short long, but just right. resectionThe Journal Cardiovascular SurgeryVol. 162Issue 3PreviewFeature Editor's Note—Resection survival majority fraction patients; “cure” term oncology providers sparingly. Recurrence new primary cancers still common cohort individuals II cancers. Consequently, radiographic become ongoing care surgically Full-Text