Follow-up Care, Surveillance Protocols and Secondary Prevention Measures for Survivors of Colorectal Cancer

Guideline Objective:

This guideline is an update to a previous version (i.e., GL 26-2 Version 2). The main objectives are:

1. To determine the surveillance regimen that leads to the largest benefit for stage I-IV colorectal cancer survivors treated with curative intent.
2. To determine preferred models of follow-up care in Ontario.
3. To identify signs and symptoms of potential recurrence and determine when to investigate.
4. To evaluate patient information and support needs during the survivorship phase.

Patient Population:

Adult colorectal cancer survivors defined as patients who have completed primary, curative treatment for colorectal cancer stages I to IV and are without evidence of disease.

Intended Users:

This guideline is targeted to:

1. Clinicians (e.g., medical oncologist, radiation oncologist, surgeon, advanced practice nurse, physician assistant, primary care provider [family physician, nurse practitioner, family practice nurse]) involved in the delivery of care for colorectal cancer survivors.
2. Healthcare organizations and system leaders responsible for offering, monitoring, or providing resources for colorectal cancer survivorship protocols.

Research Questions:

This guideline is an update to a previous version (i.e., GL 26-2 V2) and the research questions were adapted from it.

1. What is the surveillance regimen for stage I-IV colorectal cancer survivors resected with curative intent providing the largest benefit?
   
   1. What is the evidence comparing higher-intensity versus lower-intensity surveillance programs for colorectal cancer survivors treated with curative intent?
   2. What specific surveillance regimens provided the largest overall benefit for colorectal cancer survivors treated with curative intent?
2. Are there preferred models of follow-up care in Ontario, i.e., should patient follow-up be done by a medical oncologist, radiation oncologist, surgeon, nurse practitioner, physician assistant, or family physician.
3. Which symptoms and/or signs signify a potential recurrence of colorectal cancer and warrant investigation?
4. What are the individual needs and long-term and late effects for colorectal cancer survivors?
   
   1. What are the post-treatment informational and support needs for patients regarding local recurrence and common long-term and late effects of colorectal cancer?
   2. What are the common and/or substantial long-term and late treatment effects of colorectal cancer?