ORIGINAL ARTICLE Patients' preferences concerning follow-up after curative head and neck cancer treatment: A cross-sectional pilot study Simon Andreas Mueller MD 1 | Julia Riggauer MD 1 | Olgun Elicin MD 2 | Daniela Blaser PhD 1 | Sven Trelle MD 3 | Roland Giger MD 1 1 Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland 2 Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland 3 Clinical Trials Unit, University of Bern, Bern, Switzerland Correspondence Simon Andreas Mueller, Department of Oto- Rhino-Laryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland. Email: simon.mueller@insel.ch Abstract Background: Evidence of the oncological benefit of scheduled follow-up in head and neck squamous cell carcinoma is weak; symptom-oriented self-referral may be an alternative. Patients’ preferences regarding follow-up remain poorly investigated. Methods: We conducted a cross-sectional survey among patients undergoing follow- up at a tertiary outpatient clinic, focusing on their preferences, correlating factors, fear of recurrence, and willingness for participation in a randomized trial on follow-up. Results: Of 101 patients, 89.1% preferred scheduled follow-up to self-referral, 57% favored fewer visits than the current standard, and 85.1% endorsed regular imaging. Recurrence or second primary was associated with preference of intensive follow- up schedules (P = 0.02). There were trends for women and patients with high fear of recurrence score to favor intensive follow-up. Two-third of the participants declared willingness to participate in a randomized controlled trial. Conclusions: Patients' preferences only partially correspond to current follow-up guidelines. Recruitment for randomized controlled studies evaluating the value of follow-up seems feasible. KEYWORDS fear of recurrence, follow-up, head and neck cancer, patients’ preference, self- referral 1 | INTRODUCTION Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide and has a 5-year mortality of 35%-40% despite recent advances in treatment. 1 Recurrence at the local and/or regional site is common, especially during the first 2 years after treatment. 2 Moreover, there is a risk for sec- ond primaries in HNSCC associated with cigarette smoking and excessive alcohol consumption. 3 The aims of HNSCC follow-up are early detection of recurrences and second pri- maries to enhance the chances for successful salvage therapy, 4 the detection and management of treatment-related sequelae, and psycho-social support for the patients. 5,6 However, the ideal structure of follow-up is a matter of ongoing debate. Current guidelines proposed by various expert panels agree that the duration of follow-up should be at least 5 years and that periodic physical exams should be performed. 7 Guidelines consistently recommend that physical exams should be more frequent in the first 3 years after treatment, although the suggested intervals vary 7 (Supporting Informa- tion Table S1). Most guidelines also recommend radiologic assessment of treatment response after 3-6 months, but not further radiologic screening for locoregional recurrence in the absence of suspicious symptoms. 7 However, physicians are commonly confronted with relapsing patients without preced- ing symptoms, but also with symptomatic patients without evidence for recurrence. Obviously, a close follow-up may be useful to detect recurrences early in the first group to increase the chance of successful salvage. 4 In contrast, the second group of patients is likely to undergo unnecessary imaging studies and even invasive diagnostic procedures due to false Received: 18 April 2018 Revised: 10 December 2018 Accepted: 10 January 2019 DOI: 10.1002/hed.25686 Head & Neck. 2019;1–8. wileyonlinelibrary.com/journal/hed © 2019 Wiley Periodicals, Inc. 1