Published online May 15, 2014. doi: 10.4251/wjgo.v6.i5.104
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.
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.