Models of Follow-Up Care and Secondary Prevention Measures for Survivors of Colorectal Cancer: Evidence-Based Guidelines and Systematic Review

Abstract

Objective: To provide recommendations for preferred models of follow-up care for stage I-IV colorectal (CRC) cancer survivors in Ontario; to identify signs and symptoms of potential recurrence and when to investigate; and to evaluate patient information and support needs during the post-treatment survivorship period. Methods: Consistent with the Program in Evidence-Based Medicine’s standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO databases were systematically searched. The authors drafted recommendations and revised them based on the comments from internal and external reviewers. Results: Four guidelines, three systematic reviews, three randomized controlled trials, and three cohort studies provided evidence to develop recommendations. Conclusions: Colorectal cancer follow-up care is complex and requires multidisciplinary, coordinated care delivered by the cancer specialist, primary care provider, and allied health professionals. While there is limited evidence to support a shared care model for follow-up, this approach is deemed to be best suited to meet patient needs; however, the roles and responsibilities of care providers need to be clearly defined, and patients need to know when and how to contact them. Although there is insufficient evidence to recommend any individual or combination of signs or symptoms as strong predictor(s) of recurrence, patients should be educated about these and know which care provider to contact if they develop any new or concerning symptoms. Psychosocial support and empathetic, effective, and coordinated communication are most valued by patients for their post-treatment follow-up care. Continuing professional education should emphasize the importance of communication skills and coordination of communication between the patient, family, and healthcare providers.

Quality of life and symptom burden after rectal cancer surgery: a randomised controlled trial comparing patient-led versus standard follow-up

“…A recent systematic review and synthesis of qualitative evidence showed that information needs, interaction with health care professionals and support to cope and adjust to survivorship were crucial [36]. This was supported by another systematic review which also emphasised the importance of self-management instructions and clear patient information about when and how to contact healthcare professionals [37]. Self-management strategies require that patients act proactively and that clear options for self-management and support are available [38,39].…”

Myths and Presumptions About Cancer Survivorship

“…Myth: Shared Care Results in the Best Outcomes for Cancer Survivors Shared care is a term that describes deliberate efforts to coordinate components of survivorship care between specialty and primary care providers (PCPs), practice settings, or electronic health records (EHRs). Multiple reports and manuscripts recommend shared care as the preferred model for survivorship care, [5][6][7] starting with the Lost in Transition report calling for coordination between specialists and PCPs. 8 However, available data challenge the belief that shared care is superior to PCP or oncology-led care in several ways.…”