Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology

Objective: To determine the most effective, evidence based, postoperative s urveillance strategy for the detection of recurrent colon and rectal cancer . Tests are to be recommended only if they have an impact on the outcomes l isted below. Potential Intervention: All tests described in the literature for postopera tive monitoring were considered. In addition, the data were critically eval uated to determine the optimal frequency of monitoring. Outcomes: Outcomes of interest included overall and disease free survival, quality of life, toxicity reduction, and cost-effectiveness. The American S ociety of Clinical Oncology (ASCO) Colorectal Cancer Surveillance Expert Pa nel was guided by the principle of cost minimization, ie, when two strategi es were believed to be equally effective, the least expensive test was reco mmended. Evidence: A complete MEDLINE search was performed of the past 20 years of t he medical literature, Keywords included colorectal cancer, follow-up, and carcinoembryonic antigen, as well as the names of the specific tests. The s earch was broadened by articles from the tumor marker ASCO panel literature search, as well as from bibliographies of selected articles. Values: Levels of evidence and guideline grades were rated by a standard pr ocess. More weight was given to studies that tested a hypothesis directly r elating testing to one of the primary outcomes in a randomized design. Benefits/Harms/Costs: The possible consequences of false-positive and false -negative tests were considered in evaluating a preference for one of two t ests that provide similar information. Cost alone was not a determining fac tor Recommendations: The expert panel's recommended postoperative monitoring sc hemer is discussed in this article. Validation: Five outside reviewers, the ASCO Health Services Research Commi ttee, and the ASCO Board of Directors examined this document. (C) 1999 by A merican Society of Clinical Oncology.