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Follow up and outcome

The ultimate goal of patient care is to achieve the desired outcome.

For treatment with curative intent, the desired outcome is a combination of the best possible cure rate with an acceptable rate of complications. For most common tumours, the sigmoid-shaped radiation dose response curves are sufficiently close together that high rates of cure (or local control) are not possible without a measurable complication rate. As the radiation dose increases to high values, the increase in cure rate decreases whilst the complication rate increases steeply. The actual slopes and positions of these curves is a complex mixture of patient, tumour and treatment factors.

Therefore, it is necessary to accept a compromise, acknowledging that some patients will not be cured. The combination of cure and complication rates that results in the maximum rate of "uncomplicated cures" is frequently acknowledged as optimal.

In the case of palliative treatments, the goal of treatment is relief of particular symptoms and an improvement in quality of life. Again, there is often a trade-off between the rate of symptom control and the rate of treatment induced acute radiation reactions. In general the risk of late complications in palliative treatment is low, due to the generally short life expectancy of the patient.

It is necessary for centres to be aware of their own results for cure, symptom control and complication rates. This can only be achieved through a rigorous program of patient follow up and documentation. Although the published literature may provide guidance, the results from well-resourced, international centres of excellence, which dominate the literature, may not apply to centres in different countries. This is due to differences in populations, co-morbidities, diseases or disease stages, and levels of technological sophistication.

The mechanism of follow up will depend on the particular circumstances of the centre or country. In urban areas, clinic attendance may be feasible. This should be encouraged for patients treated curatively, but may not be appropriate following palliative treatments. In rural regions, clinic attendance may be possible at satellite clinics or with family doctors; alternatively telephone or other methods of communication may be required.

Whatever the mechanism, it is desirable that documentation is obtained regarding the status of the patient. Ideally, this information is recorded according to validated scoring systems. Many scoring systems have been developed for the acute and late affects of radiation. This information is then transferred to a database for subsequent analysis and reporting.

It is only through a commitment to follow up, recording and analysis that centres can be confident that they are achieving the desired result.