Patient and Clinician Perspectives on Implementing Remote Surveillance after Lung Cancer Surgery: A Qualitative Analysis.

Abstract

Background: Remote surveillance may reduce barriers to lung cancer surveillance after curative-intent surgery, but implementation requires understanding how patients and clinicians value and experience follow-up care. We explored patient and clinician perspectives to inform development and implementation of REmote Telehealth User-Reported caNcer Surveillance (RETURNS).

Study design: We conducted a qualitative study using semi-structured interviews with patients who had completed curative-intent lung cancer surgery and clinicians involved in lung cancer surveillance in the United States from August 2024 to December 2025. Transcripts were analyzed using an interpretive description approach.

Results: Among 64 participants (45 patients, 19 clinicians), patient-, clinician-, and system-level considerations for remote surveillance were identified through 6 themes. Patients' "willingness to fight" minimized perceived surveillance burdens, while "desire for peace of mind" reflected reassurance derived from obtaining and reviewing surveillance imaging in person. "Fear of abandonment" captured patients' desire to maintain relationships with their clinical teams. Clinicians identified "roadblocks ahead," including technological, reimbursement, and regulatory barriers; a "need for trusted systems," reflecting concerns about outside imaging quality, interpretation, and accessibility; and "time for goodbye," reflecting surgeons' view that surveillance responsibilities may appropriately transition as their role diminishes during survivorship.

Conclusions: Remote lung cancer surveillance implementation must address more than convenience. Strategies should preserve reassurance and continuity while addressing technological access, telehealth barriers, inter-system imaging quality and exchange, and transitions in clinician roles during survivorship.