Follow-up of patients with colorectal cancer: A review

This study is the second update of a review focusing on the effects of an intense follow-up for patients with colorectal cancer after treatment.

Patients with colorectal cancer who underwent surgery or adjuvant therapy (treatment following surgery) are followed for several years. However, multiple appointments and tests can be inconvenient and expensive for patients. It is still not clear how often patients should be seen, or what tests should be done, and what the effect this type of follow-up has on patient outcomes.

This study reviewed the effects of intensive follow-up for patients with colorectal cancer treated with surgery or adjuvant therapy, or both.

This study reviewed other 15 studies including information about 5403 patients. Patients had different follow-up periods, did a different number of tests during follow-up, and were examined by surgeons, physicians or nurses. An intensive follow-up was greater follow-up periods (over 48 months) and more tests.

Twelve studies reported on overall survival (time from treatment until death from any cause). There were no differences in the overall survival in patients under an intensive follow-up compared to minimal follow-up.  

Seven studies reported no difference in the cancer-related survival (time from treatment until death due to cancer) in patients under an intensive follow-up.  

Fourteen studies reported no difference in the time until disease relapse.

Thirteen studies reported that a second surgery was more frequent with intense follow-up. Patients under intensive follow-up had a 98% increased risk of undergoing further surgery.

Seven studies reported that recurrences (when the cancer comes back) were less frequent in patients under an intensive follow-up. These patients had a 41% decrease in recurrences.  

Three studies reported that intensive follow-up does not affect quality of life, anxiety nor depression.

Two studies noted that side effects of colonoscopies (a test that examines the inner lining of the intestine) did not differ with intensive follow-up.

This review determined that there is no overall survival benefit in intensive follow-up. The authors noted that these patients had more curative surgery and fewer recurrences. 

A limited number of studies were reviewed for the colonoscopy side effects.