Background: The evidence for the benefit of surveillance and optimum surveillance schedules for patients with treated cancer is unclear. Service utilisation for this large group may be able to be reduced.
Aim: To develop a set of minimum recommendations of surveillance for patients with breast, lung (NSCLC and SCLC), colon and rectal cancer who have completed curative intent treatment.
Methods: The recommendations from international guidelines for surveillance follow-up and imaging after treatment for early stage or locally advanced cancer were compared. Recommendations were sought from ESMO, ASCO and NCCN. The minimum surveillance recommendations that could be implemented was then determined.
Results: There was significant heterogeneity across guidelines from the different organisations in terms of frequency and actual recommendations. The main minimum recommendations elucidated include: for breast cancer, a minimum of annual follow-up with annual mammography; for NSCLC, a minimum of 6 monthly follow-up for 2 years, then annual follow-up, with annual CT chest and upper abdomen imaging for 2 years, followed by low dose CT chest annually. For limited stage SCLC, the minimum recommendation for follow-up and imaging was 6 monthly for 2 years. For colon cancer, the minimum recommendation for follow-up was 6 monthly for 5 years, with annual CT imaging for 3 years. This is alongside separate recommendations regarding colonoscopy. For rectal cancer, the minimum recommended follow-up was 6 monthly for at least 3 years, with two CT scans in that time, and colonoscopies every 5 years.
Conclusion: A set of minimum surveillance recommendations was developed for common cancers after curative intent treatment. This could be helpful for local institutions to audit current practice and to implement for optimal resource utilisation. Further work can focus on what health professional is best suited for follow-up, including oncologist, surgeon and general practitioner.
*CT - computerised tomography