Health professionals performing follow-up and suggested follow-up schedule
Overview of evidence (non-systematic literature review)[edit source]
No systematic reviews were undertaken for this topic. Practice points were based on selected evidence and consensus. See Guidelines development process.
Health professionals performing follow-up[edit source]
It has not been established whether outcomes differ by provider of follow-up care. For example it has not been established whether intensive (hospital-based) follow up is associated with a survival advantage over care provided by a general practitioner or clinical nurse consultant in colorectal cancer. Further studies are needed to determine whether community-based follow up can be adequately performed without decreasing patient survival, and to define the optimal balance between follow-up care provided by the general practitioner or clinical nurse consultant and the specialist.
Follow-up can be delivered as a combination of visits to the surgeon or associated gasteroenterologist, with ongoing care by the GP and clinical nurse consultant.
Suggested follow-up schedule[edit source]
After the routine review post discharge, patients should be reviewed at 3- to 6-monthly intervals for the first year (3 monthly in those patients who had poor prognostic factors such a positive margin, T4 disease and/or lymph node involvement, patients with stage III disease who decline chemotherapy), 6-monthly for the next two years and then yearly for a total of 5 years. There is no consensus on these intervals, as evidenced by the variability in follow-up protocols in the published literature, but there are organisations that would support a similar follow-up schedule. This is a guide for the clinician and further trials will be necessary to establish optimal protocols. Less intensive follow-up may be considered for patients with early cancers (T1-2, N0) after discussion with the patient.
Clinical assessment includes history and physical examination. Regular carcinoembryonic antigen (CEA) measurement (at each consultation) and annual computed tomography (CT) should be considered in follow-up protocols as they may provide useful in early detection of recurrence and the potential for surgery with curative intent. Positron emission tomography (PET/CT) can be an effective alternative to standard CT after detection of a significant rise in CEA.
Colonoscopy should be performed 12 months after surgery to exclude missed lesions. If the patient did not have complete colonoscopy prior to surgery, then this should be performed at the latest 6 months after surgery. If the post-operative colonoscopy is normal then future surveillance should be according to the Clinical Practice Guidelines for Surveillance Colonoscopy.
Future studies should focus on the cost-effectiveness and efficiency of investigations employed.
- Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minsky BD, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol 2013 Dec 10;31(35):4465-70 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24220554.
- National Comprehensive Cancer Network. NCCN Guidelines: Colon Cancer. National Comprehensive Cancer Network; 2016.
- National Comprehensive Cancer Network. NCCN Guidelines for Rectal Cancer Version 2.; 2016 Available from: https://www.tri-kobe.org/nccn/guideline/colorectal/english/rectal.pdf.
- Yu T, Meng N, Chi D, Zhao Y, Wang K, Luo Y. Diagnostic Value of (18)F-FDG PET/CT in Detecting Local Recurrent Colorectal Cancer: A Pooled Analysis of 26 Individual Studies. Cell Biochem Biophys 2015 Jun;72(2):443-51 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25737131.
- Peng NJ, Hu C, King TM, Chiu YL, Wang JH, Liu RS. Detection of resectable recurrences in colorectal cancer patients with 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography. Cancer Biother Radiopharm 2013 Jul;28(6):479-87 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23713869.
- Culverwell AD, Chowdhury FU, Scarsbrook AF. Optimizing the role of FDG PET-CT for potentially operable metastatic colorectal cancer. Abdom Imaging 2012 Dec;37(6):1021-31 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22371087.
- Ohlsson B, Pålsson B. Follow-up after colorectal cancer surgery. Acta Oncol 2003;42(8):816-26 Available from: http://www.ncbi.nlm.nih.gov/pubmed/14968942.