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World J Gastrointest Oncol. May 15, 2014; 6(5): 104-111
Published online May 15, 2014. doi: 10.4251/wjgo.v6.i5.104
Do the benefits outweigh the side effects of colorectal cancer surveillance? A systematic review
Knut Magne Augestad, Johnie Rose, Benjamin Crawshaw, Gregory Cooper, Conor Delaney
Knut Magne Augestad, Benjamin Crawshaw, Conor Delaney, Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106, United States
Knut Magne Augestad, Department of Gastrointestinal Surgery, University Hospital North Norway, 9037 Breivika, Tromsø, Norway
Knut Magne Augestad, Norwegian National Center of Integrated Care and Telemedicine, Tromsø, Norway
Johnie Rose, Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States
Gregory Cooper, Case Comprehensive Cancer Center, Cleveland, OH 44106, United States
Gregory Cooper, Department of Gastroenterology, University Hospitals Case Medical Center, Cleveland, OH 44106, United States
Author contributions: Augestad KM, Rose J, Crawshaw B, Cooper G and Delaney C solely contributed to this paper.
Supported by Norwegian Health Authorities Research Grant
Correspondence to: Knut Magne Augestad, MD, PhD, Department of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States.
Telephone: +1-47-97499442 Fax: +1-47-97499442
Received: November 26, 2013
Revised: February 12, 2014
Accepted: April 16, 2014
Published online: May 15, 2014

Most patients treated with curative intent for colorectal cancer (CRC) are included in a follow-up program involving periodic evaluations. The survival benefits of a follow-up program are well delineated, and previous meta-analyses have suggested an overall survival improvement of 5%-10% by intensive follow-up. However, in a recent randomized trial, there was no survival benefit when a minimal vs an intensive follow-up program was compared. Less is known about the potential side effects of follow-up. Well-known side effects of preventive programs are those of somatic complications caused by testing, negative psychological consequences of follow-up itself, and the downstream impact of false positive or false negative tests. Accordingly, the potential survival benefits of CRC follow-up must be weighed against these potential negatives. The present review compares the benefits and side effects of CRC follow-up, and we propose future areas for research.

Keywords: Colorectal cancer, Follow-up, Surveillance, False positive, Cancer survivorship

Core tip: Most western countries have a national follow-up program for colorectal cancer (CRC) survivors. The reported reduction in absolute mortality from intensive follow-up is 5%-10%, though recent data from the follow-up after colorectal surgery randomized trial call this effect into question. There exists limited evidence of improved quality of life (QoL) due to participation in a follow-up program, and the impact of false positive tests on QoL might be considerable. Several national experts advocate for low-cost, low-intensity CRC follow-up programs.