One study has reported that some simple tests and environmental factors can extend the survival time of patients with head and neck cancer. Those patients who were strictly followed up after treatment, quit smoking and lived 200 miles away from a medical center had longer survival times. This result is significant because head and neck cancer patients are expected to survive longer, generally with a 5-year survival rate of about 50 percent. 50 percent of deaths are largely attributed to residual tumor, recurrence and metastasis. Researchers have found that regular follow-up examinations can detect half of the cancer recurrences as early as possible. However, the questions of how often to review and how many reviews in total are controversial in academic circles. This retrospective study of 332 head and neck cancer patients seen at KUMC between 2003 and 2008 tells us not only what factors are beneficial for survival, but also which patients are at high risk for recurrence and metastasis. Patients who are reluctant to review, patients who continue to smoke, patients with low to moderate income, and patients who live more than 200 miles from a medical center are at high risk for tumor recurrence and metastasis and need attention. Patients were categorized into high, medium, and low adherence according to their compliance. Highly adherent patients were reviewed strictly every 4 weeks, medium adherent patients occasionally missed one or two appointments, and low adherent patients missed more than 3 appointments. The results showed that patient adherence significantly improved survival, with statistically significant differences. In addition, high-income individuals had a better prognosis than low- and middle-income individuals. Patients who quit smoking who lived within 200 miles had a better prognosis. And risk factors for death included: advanced tumors, low to moderate income, and advanced age. The researchers noted that more frequent follow-up did not significantly improve the survival rate of patients with head and neck cancer. More frequent follow-up visits also added additional psychological stress to patients and cost more time and transportation costs. However, they suggest that those patients with high-risk factors should use a more rigorous follow-up review strategy, through which physicians can improve their compliance and make it easier to detect tumor recurrence.