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

Version: 2 ID: 26-2 Mar 2016
Type of Content: Guidelines & Advice, Clinical
Document Status: Current
Authors:
Members of the Colorectal Cancer Survivorship Group

Guideline Objective

The Program in Evidence-based Care (PEBC) of Cancer Care Ontario undertook this survey of practice guidelines in order to create a reasonable, specific follow-up protocol for survivors of CRC, with two purposes:

  • to facilitate different models of survivorship care by having a guidance document with which any clinician (e.g., non-specialist physician, advanced practice nurse) would be able to provide follow-up care to survivors of CRC and
  • to allow standards for overuse and underuse to be developed, against which practice could be measured and reported.

Patient Population

CRC survivors: adult patients who have completed primary treatment for stage II or III disease and are without evidence of disease. Whether these recommendations are extrapolated to stage I patients is left to the discretion of the healthcare provider.

Intended Guideline Users

  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 CRC survivors.
  2. Patients and family of patients who have survived CRC.
  3. Healthcare organizations and system leaders responsible for offering, monitoring, or providing resources for CRC survivorship protocols.

Research Question(s)

In colorectal cancer (CRC) survivors (adult patients who have completed primary treatment for stage II or III CRC and who are without evidence of disease):

  1. Which evaluations (e.g., colonoscopy, computed tomography [CT], carcinoembryonic antigen [CEA], liver function, complete blood count [CBC], chest x-ray, history, physical exam) should be performed for surveillance for recurrence of cancer?
  2. What is a reasonable frequency of these evaluations for surveillance?
  3. Which symptoms and/or signs potentially signify a recurrence of CRC and warrant investigation?
  4. What are the common and/or significant long-term and late effects of CRC treatment?
  5. On what secondary prevention measures should CRC survivors be counselled?
  6. 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, advanced practice nurse, physician assistant, or primary care provider (e.g., family physician, nurse practitioner, family practice nurse)?
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