Do the benefits outweigh the side effects of colorectal cancer surveillance? A systematic review

Abstract

Most patients treated with curative intent for colorectal cancer (CRC) are included in a follow-up program involving periodic evaluations. The survival benefits of a follow-up program are well delineated, and previous meta-analyses have suggested an overall survival improvement of 5%-10% by intensive follow-up. However, in a recent randomized trial, there was no survival benefit when a minimal vs an intensive follow-up program was compared. Less is known about the potential side effects of follow-up. Well-known side effects of preventive programs are those of somatic complications caused by testing, negative psychological consequences of follow-up itself, and the downstream impact of false positive or false negative tests. Accordingly, the potential survival benefits of CRC follow-up must be weighed against these potential negatives. The present review compares the benefits and side effects of CRC follow-up, and we propose future areas for research.

Keywords: Cancer survivorship; Colorectal cancer; False positive; Follow-up; Surveillance.

Figure 1

Overall survival of colon cancer dukes A-D. Eighty percent of the recurrences occur within the 3 first years after initial treatment, which is used as an argument to perform intensive surveillance the first 3 years. After 5 years, the survival curve is steady with few deaths caused by colon cancer. Courtesy of the Norwegian Cancer Registry (http://www.kreftregisteret.no/en/).

Figure 2

Factors influencing quality of life among colorectal cancer survivors enrolled in a follow-up program. CRC: Colorectal cancer.