A systematic review comparing surveillance recommendations for the detection of recurrence following surgery across 16 common cancer types

Abstract

ObjectivesIdentify and compare guidelines making recommendations for surveillance to detect recurrence in 16 common solid cancers after initial curative treatment in asymptomatic patients.Methods and analysisWe conducted a systematic review, combining search results from two electronic databases, one guideline organisation website (NICE), expert consultation and manual searching. Screening and data extraction were carried out by multiple reviewers. We collected data from each guideline on recommendations for surveillance and the use of risk stratification. Findings were compared between cancer types and regions. Text mining was used to extract statements on the evidence for surveillance. A protocol was published on PROSPERO in 2021 (CRD42021289625).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 frequency, length and mode of surveillance was widespread, with most guidelines (n=92, 74.8%) recommending that surveillance be adapted based on patient risk. More than a third (n=50, 39.0%) gave incomplete or vague recommendations. For 14 cancers, we found statements indicating there is no evidence that surveillance improves survival.ConclusionAlthough specific details of follow-up schedules vary, common challenges were identified across cancer types. These include heterogenous recommendations, vague or non-specific guidance and a lack of cited evidence supporting the use of surveillance to improve outcomes. Evidence generation in this area is challenging; however, increased availability to linked health records may provide a way forward.PROSPERO registration numberCRD42021289625.