Is intensive follow-up of patients after curative surgery for colorectal cancer effective in reducing mortality? Our September Paper of the Month looks at an article on the COLOFOL randomized clinical trial.
What is known on the subject?
Numerous international guidelines advise on careful follow up after colorectal cancer resection largely predicated on the notion that earlier detection of recurrence allows earlier treatment and improved survival. Such recommendations include intense follow up using serial CEA assay, CT and endoscopy. Previous studies have questioned the need for intense follow up and the potential for benefit.
What this study adds?
This study adds to other trials including the NCDB study from the US and the FACS trial from the UK in suggesting that intense follow up (defined in this trial as CEA testing and CT scanning 6 monthly for 3 years) for stage II or III colorectal cancer results in no difference in mortality and cancer specific mortality 5 years after surgery when compared to low intensity follow up (CT at 12 months and 3 years).
Implications for colorectal practice?
Whilst the pragmatic design of this trial had some drawbacks the methodology was sound, numbers large and follow up exceptional. The combination with similar results from the other well-conducted trials mean that guidelines for surveillance of these patients should be re-evaluated and standardized to recommend a less intense surveillance regime. There may be scope in the future to tailor follow up intensity based on as yet unproven cancer biology risk factors to further improve the outcomes after oncological therapy.
Wille-Jørgensen P, Syk I, Smedh K, Laurberg S, Nielsen DT, Petersen SH, Renehan AG, Horváth-Puhó E, Påhlman L, Sørensen HT; COLOFOL Study Group. Effect of More vs Less Frequent Follow-up Testing on Overall and Colorectal Cancer-Specific Mortality in Patients With Stage II or III Colorectal Cancer: The COLOFOL Randomized Clinical Trial. JAMA. 2018 May 22;319(20):2095-2103.
