Pulmonary Screening Practices of Otolaryngology-Head and Neck Surgeons Across Saudi Arabia in the Posttreatment Surveillance of Squamous Cell Carcinoma: Cross-sectional Survey Study

Background: With respect to patients with head and neck squamous cell carcinoma (HNSCC), posttreatment surveillance for distant disease has mostly focused on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of HNSCC cases. Additionally, the incidence rate of primary tumors in the lungs is high due to the field cancerization of the entire upper aerodigestive tract. Objective: Our cross-sectional survey study aims to evaluate the current beliefs and pulmonary screening practices of otolaryngology-head and neck surgeons across Saudi Arabia with respect to the posttreatment surveillance of HNSCC. Methods: This nationwide cross-sectional survey was conducted among head and neck surgeon members of the Saudi Society of Otolaryngology from June 1 to June 30, 2020. A predesigned questionnaire was used for data collection, and a descriptive analysis was carried out. Results: This study included 22 participants and had a 78% (22/28) response rate. This study found that the majority of participants (9/22, 41%) used lung radiography for routine lung screening during posttreatment follow-ups, whereas 32% (7/22) used low-dose computed tomography (CT; 7/22, 32%). With regard to the number of years for which participants perform lung screening during follow-ups, the majority of participants (17/22, 77%) reported 5 years, and only 9% (2/22) have performed lifelong lung screening. With regard to the frequency of lung screening, 77% (17/22) of participants conduct screening annually, 18% (4/22) conduct screening half-yearly, and 5% (1/22) conduct screening biennially. With regard to beliefs about the effectiveness of screening procedures in reducing lung cancer mortality rates during follow-ups, 36% (8/22) of participants believed them to be very effective or somewhat effective, 18% (4/22) did not know, and only 9% (2/22) believed that they were not effective. Conclusions: The participants mainly used lung radiography (9/22, 41%), low-dose CT (7/22, 32%), or positron emission tomography/CT (6/22, 27%) as a routine lung screening method during the posttreatment follow-up of patients with head and neck cancer for 5 years (17/22, 77%) or 10 years (3/22, 14%), and only a small percentage of participants have performed lifelong lung screening (2/22, 9%). Lung screening was mostly conducted annually or half-yearly. Such screening was believed to be very effective or somewhat effective.