ASCO Endorses Cancer Care Ontario Guideline for Follow-up in Colorectal Cancer Survivors
ASCO has policy and procedures for endorsing clinical practice guidelines developed by other professional organizations. As reported in the Journal of Clinical Oncology by Meyerhardt et al of the ASCO Clinical Practice Guidelines Committee, ASCO has endorsed the Cancer Care Ontario (CCO) Guideline on Follow-up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer, with the addition of qualifying statements.
The CCO guideline covers follow-up, surveillance, and secondary prevention measures for survivors of stage II and III colorectal cancer; there are insufficient data to support guidelines on stage I colorectal cancer and resected metastatic disease. The overall ASCO key recommendations reflecting the CCO guideline and ASCO qualifications are as follows.
ASCO Key Recommendations
- Surveillance should be guided by presumed risk of recurrence and functional status of patient when early detection would lead to aggressive treatment including surgery. Surveillance is especially important in the first 2 to 4 years due to greater risk of recurrence during this period.
- Medical history, physical examination, and carcinoembryonic antigen testing should be performed every 3 to 6 months for 5 years. This frequency of visits and testing is based on the available data indicating that 80% of recurrences occur in the first 2 to 2.5 years from date of surgery and that 95% occur by 5 years. Patients at higher risk of recurrence should have more frequent visits and testing.
- Abdominal and chest computed tomography (CT) imaging is recommended annually for 3 years. Imaging every 6 to 12 months for the first 3 years should be considered for high-risk patients. Positron emission tomography (PET) scans are not recommended for surveillance outside of the clinical trial setting.
- Pelvic CT is also recommended for patients with rectal cancer. Clinical assessment of risk status should determine the frequency of pelvic scans (eg, annually for 3 to 5 years). Rectosigmoidoscopy should be performed every 6 months for 2 to 5 years in patients who have not received pelvic radiation.
- Surveillance colonoscopy should be performed approximately 1 year after initial surgery, with the frequency of subsequent surveillance colonoscopies being dictated by the findings of the previous colonoscopy; however, they generally should be performed every 5 years if the findings of the previous colonoscopy are normal. If colonoscopy was not performed before diagnosis, it should be performed as soon as reasonable after completion of adjuvant therapy and not necessarily at the 1-year time point.
- New and persistent or worsening symptoms warrant consideration of recurrence.
- There is a lack of high-quality evidence on secondary prevention, but it is reasonable to counsel patients to maintain a healthy body weight, be physically active, and eat a healthy diet.
- A treatment plan from the specialist should be provided to the patient’s other providers, particularly the primary care physician, and the plan should contain clear directions on appropriate follow-up.
- Surveillance tests should not be performed in patients who are not surgical candidates or candidates for systemic therapy due to severe comorbid conditions.
The American Society of Clinical Oncology is the corresponding author for the Journal of Clinical Oncology article.
The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
