This is an original JCO publication from 2005. Please visit the JCO website to access the full article.
Follow-Up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement
Jeffrey A. Meyerhardt, Pamela B. Mangu, Patrick J. Flynn, Larissa Korde, Charles L. Loprinzi, Bruce D. Minsky, Nicholas J. Petrelli, Kim Ryan, Deborah H. Schrag, Sandra L. Wong, and Al B. Benson III
ASCO endorses the CCO Practice Guideline on Follow-up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of CRC, with qualifying statements
- Follow-up, surveillance, and secondary prevention measures for survivors of CRC, stages II and III (not stage I or resected metastatic disease, both of which have minimal data to provide guidance
- Medical, surgical, and radiation oncologists, primary care providers, and others involved in the delivery of care for CRC survivors
- Patients and family members of patients who have survived CRC
ASCO Key Recommendations
Surveillance should be guided by presumed risk of recurrence and functional status of patient where early detection would lead to aggressive treatment including surgery. It is especially important in the first 2 to 4 years, when the risk of recurrence is the greatest.
A medical history, physical examination, and CEA testing should be performed every 3 to 6 months for 5years. The frequency of visits and testing should be driven by the data showing that 80% of recurrences occur in the first 2 to 2.5 years from date of surgery and 95% occur by 5 years. Patients at a higher risk of recurrence should be considered for testing in the more frequent end of the range.
Abdominal and chest imaging using a CT scan is recommended annually for 3years. For high-risk patients, it is reasonable to consider imaging every 6 to 12 months for the first 3 years. Outside of a clinical trial, PET scans are not recommended for surveillance.
For patients with rectal cancer, a pelvic CT is also recommended. Clinician judgment, considering risk status, should be used to determine the frequency of pelvic scans (eg, annually for 3 to 5 years). For those patients who have not received pelvic radiation, a rectosigmoidoscopy should be performed every 6 months for 2 to 5 years.
A surveillance colonoscopy should be performed approximately 1 year after the initial surgery. The frequency of subsequent surveillance colonoscopies should be dictated by the findings of the previous one, but they generally should be performed every 5 years if the findings of the previous one are normal. If a complete colonoscopy was not performed before diagnosis, a colonoscopy should be done as soon as reasonable after completion of adjuvant therapy and not necessarily at the 1-year time point.
Any new and persistent or worsening symptoms warrant the consideration of a recurrence.
Despite the lack of high-quality evidence on secondary prevention in CRC survivors, it is reasonable to counsel patients on maintaining a healthy body weight, being physically active, and eating a healthy diet.
A treatment plan from the specialist should be sent to the patient’s other providers, particularly the primary care physician, and it should have clear directions on appropriate follow-up.
If a patient is not a surgical candidate or a candidate for systemic therapy because of severe comorbid conditions, surveillance tests should not be performed.
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