What Is the Appropriate Timetable and Exams Density for Tailored Follow-Up?

Abstract

After completion of treatment for colorectal cancer, patients are offered a control program. This program can be split into aftercare and follow-up. Aftercare is meant to treat and to support the patient in the somatic and psychologic sequelae of the intensive treatment. In most cases, the patient has adopted to these consequences after 1 year. In this period, follow-up has already been started to detect recurrent disease in curatively treated patients. The rationale behind this scheduled follow-up is to detect asymptomatic recurrent disease as early as possible and by that increase the rate of curable recurrences followed by a better survival in a cost-effective way. Traditionally it consists of anamnesis, physical examination, blood tests, and imaging. Timing and duration has been debated for many years with endless discussions about the definition of minimal or intensive schedule, but guidelines all over the world have incorporated a kind of follow-up schedule in their national or institutional guidelines. However, evidence for a certain schedule of follow-up is based on old, often poor, designed studies with inclusion of the patients in the 1970s and 1980s of the last century, when surgery was suboptimal and the preoperative staging more or less missing. The subsequent meta-analyses have included all these old series and are the rationale of today’s practice. In general, the conclusion is that a kind of follow-up results in an improved survival, but it is not possible to determine the best combination of tests and the frequency.