The Follow-Up Visit

"Experience is simply the name we give our mistakes."
-Oscar Wilde


A long-term cancer survivor comes for a regularly scheduled follow-up clinic visit. These usually routine appointments focus on problem-solving. It is quickly apparent, however, that she is in significant pain and has lost weight.

"How long have you had this neck mass?" I asked.

"It appeared shortly after my last visit and has been growing ever since. It hurts."

My heart sinks. Her cancer has spread. We will order scans and probably schedule surgery. The outlook is not good. Why hadn't she called for an appointment when she first noticed the mass? She shrugs. "I'm not sure."

This scenario is all too common. Researchers at Ohio State University collected information on over 3,600 follow-up clinic encounters and found that a new or recurrent cancer was identified at 5 percent of the visits. Of these, the patients had already diagnosed themselves 79 percent of the time; the physicians rarely found non-symptomatic cancers. Oddly, the confirmation of the cancer occurred at a regularly scheduled visit 73 percent of the time; patients rarely called and scheduled an early encounter. (Agrawal A, Laryngoscope Feb 2004; 114:232)

Why don't patients with symptoms call immediately for an appointment? Maybe they don't believe that cancer can recur. Maybe the visits are too expensive or frightening. Maybe they don't want to deal with potential bad news and more treatment.

Somehow, we haven't found simple ways to encourage patients to return as soon as they are alerted by a symptom or sign. In my practice, a worried, symptomatic patient often apologizes for taking up my time after I tell them everything is fine. I, on the other hand, am delighted and relieved when the symptom has a non-cancer explanation. I reassure and congratulate them, schedule another visit, take a breath, and move down the hall to see the next patient.