Summary: A Need for Clearer Surveillance Guidance
New findings published in JAMA Network Open reveal that the National Comprehensive Cancer Network (NCCN) clinical practice guidelines fall short when it comes to explicit recommendations on surveillance for cancer patients treated with curative intent. The study suggests that while the guidelines address many aspects of initial treatment and follow-up, they leave clinicians without precise, standardized paths for post-treatment surveillance. This gap can influence follow-up frequency, test selection, and patient counseling, potentially impacting early relapse detection and patient anxiety.
What the Findings Show
Researchers analyzed NCCN guideline documents across several cancer types and stages, focusing on surveillance intervals, imaging modalities, laboratory tests, and the overall structure of follow-up care. They found variability in recommendations, with some cancers offering detailed intervals and tests, while others left clinicians with generalized statements or placeholders. The lack of specificity may contribute to inconsistent practice patterns and may complicate shared decision-making between patients and their care teams.
Clinical Implications
Surveillance after curative-intent treatment is a critical phase. Effective follow-up can detect recurrences at stages when they are most treatable, monitor for late effects of therapy, and provide ongoing support for survivors. When guidelines are unclear, clinicians often rely on local protocols, personal experience, or patient preferences, which can lead to variability in care. The study’s authors argue that more concrete recommendations could improve uniformity in practice, reduce unnecessary testing, and streamline care coordination across primary care and oncology teams.
Why This Gap Matters for Survivors
For patients, the surveillance period can last years or even decades. Clear rules about what tests to expect, how often they should be performed, and what a normal result means are essential for reducing anxiety and ensuring timely intervention if a recurrence occurs. In the absence of precise NCCN guidance, patients might receive mixed messaging about symptoms to report, recommended imaging, or laboratory monitoring. Transparent, evidence-based surveillance plans can empower survivors to participate actively in their ongoing care.
Path Forward: Calls for Standardization
Experts urge the NCCN and the broader oncology community to develop standardized surveillance frameworks that apply across cancer types when possible, or clearly define cancer-specific paths that reflect current evidence about recurrence patterns and late effects. Recommendations might include consensus-driven intervals (e.g., every 3–6 months for the first two years, then annually), specific imaging modalities (such as CT, MRI, or ultrasound), and selective laboratory tests tied to particular tumor markers or organ function assessments.
Balancing Benefit and Burden
Any surveillance strategy must balance the potential benefits of early recurrence detection with the risks and burdens of testing, including radiation exposure, false positives, patient anxiety, and cost. The study highlights the need for decision aids and patient-centered communication to help individuals understand the rationale behind surveillance plans and to tailor follow-up to personal risk factors, comorbidities, and life circumstances.
What Clinicians and Researchers Can Do Now
In the short term, clinicians can advocate for clearer local protocols that align with the best available evidence and provide patients with written follow-up plans. In parallel, researchers should prioritize generating high-quality data on recurrence risk, late effects, and the impact of surveillance strategies on outcomes and quality of life. Collaborations across institutions can help build robust guidelines that reduce heterogeneity in practice and support shared decision-making.
Conclusion
The JAMA Network Open study underscores a concrete gap in NCCN cancer surveillance guidelines—one that affects patient care long after curative treatment ends. By pushing for precise, standardized surveillance recommendations, the oncology field can improve the consistency of care, optimize early detection of recurrences, and strengthen support for cancer survivors during long-term follow-up.
