Recommendations on surveillance for recurrence in asymptomatic patients following surgery in 16 common cancer types: a systematic review

ObjectivesTo identify and compare guidelines which make recommendations surveillance for the detection of recurrence for 16 common solid cancers after initial treatment with curative intent in asymptomatic patients. DesignWe conducted a systematic review, combining search results from two electronic databases (MEDLINE, EMBASE) and one guideline organisation website (NICE), as well as using expert consultation and manual searching. Screening and data extraction were carried out by multiple reviewers. We collected data from each guideline on the recommendations for surveillance and the use of risk-stratification. Findings were compared between cancer types and regions. Text mining was used to extract statements commenting on the evidence for surveillance. ResultsWe identified 123 guidelines across 16 cancer types. Almost all guidelines (n=115, 93.5%) recommend routine surveillance for recurrent disease in asymptomatic patients after initial treatment. Around half (n=59, 51.3%) recommend indefinite or lifelong surveillance. The most common modality of surveillance was cross-sectional imaging. Risk-stratification of the frequency, length, and mode of surveillance was widespread, with most of the guidelines (n=92, 74.8%) recommending that surveillance be adapted based on assessment of patient risk. More than a third of the included guidelines (n=50, 39.0%) provided incomplete or vague recommendations about surveillance. For fourteen of the included cancers, we found statements in the guidelines indicating that there is no evidence that surveillance improves survival. ConclusionsAlthough specific details of follow-up schedules vary, common challenges were identified across the 16 included cancer types. These include heterogeneity between recommendations for the same cancer type, vague or non-specific recommendation and a lack of cited evidence to support use of surveillance to improve outcomes for patients. Challenges in generating evidence in this area remain, however, increased availability to linked health records may provide a way forward for researchers. RegistrationProtocol published on PROSPERO in 2021 (ID: CRD42021289625)