Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement.
OBJECTIVE
The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing recent clinical practice guidelines that have been developed by other professional organizations.


METHODS
The Cancer Care Ontario (CCO) Guideline on Follow-up Care, Surveillance Protocol, and Secondary Prevention Measures for Survivors of Colorectal Cancer was reviewed by ASCO for methodologic rigor and considered for endorsement.


RESULTS
The ASCO Panel concurred with the CCO recommendations and recommended endorsement, with the addition of several qualifying statements.


CONCLUSIONS
Surveillance should be guided by presumed risk of recurrence and functional status of the patient (important within the first 2 to 4 years). Medical history, physical examination, and carcinoembryonic antigen testing should be performed every 3 to 6 months for 5 years. Patients at higher risk of recurrence should be considered for testing in the more frequent end of the range. A computed tomography scan (abdominal and chest) is recommended annually for 3 years, in most cases. Positron emission tomography scans should not be used for surveillance outside of a clinical trial. A surveillance colonoscopy should be performed 1 year after the initial surgery and then every 5 years, dictated by the findings of the previous one. If a colonoscopy was not preformed before diagnosis, it should be done after completion of adjuvant therapy (before 1 year). Secondary prevention (maintaining a healthy body weight and active lifestyle) is recommended. If a patient is not a candidate for surgery or systemic therapy because of severe comorbid conditions, surveillance tests should not be performed. A treatment plan from the specialist should have clear directions on appropriate follow-up by a nonspecialist.
Jeffrey A. Meyerhardt and Deborah H. Schrag, Dana-Farber Cancer Institute, Boston, MA; Pamela B. Mangu, American Society of Clinical Oncology; Kim Ryan, Fight Colorectal Cancer, Alexandria, VA; Patrick J. Flynn, Minnesota Oncology, Minneapolis; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; Larissa Korde, University of Washington, Seattle, WA; Bruce D. Minsky, MD Anderson Cancer Center, Houston, TX; Nicholas J. Petrelli, Helen Graham Cancer Center, Newark, DE; Sandra L. Wong, University of Michigan Medical School, Ann Arbor, MI; and Al B. Benson III, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL.
Jeffrey A
JA
Meyerhardt
Pamela B
PB
Mangu
Patrick J
PJ
Flynn
Larissa
L
Korde
Charles L
CL
Loprinzi
Bruce D
BD
Minsky
Nicholas J
NJ
Petrelli
Kim
K
Ryan
Deborah H
DH
Schrag
Sandra L
SL
Wong
Al B
AB
Benson
D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008495:Medical Oncology / Q000379:methods; D009864:Ontario; D011159:Population Surveillance / Q000379:methods*; D055502:Secondary Prevention / Q000379:methods*; D012955:Societies, Medical; D017741:Survivors; D014481:United States