Gaps in Surveillance Guidance for Survivors
Recent findings published in JAMA Network Open cast doubt on the clarity of cancer surveillance recommendations within the National Comprehensive Cancer Network (NCCN) clinical practice guidelines. The analysis suggests that while NCCN guidelines broadly address post-treatment care, they fall short in offering concrete, cancer-specific surveillance protocols for patients treated with curative intent. This ambiguity can leave clinicians balancing vigilant follow-up with the risks and burdens of over-testing and anxiety for patients who have already endured curative treatment.
What the Findings Reveal
Researchers scrutinized NCCN guidelines across cancer types to assess the specificity and practicality of surveillance recommendations. They found that many guidelines discuss surveillance in general terms but omit actionable details such as who should be surveilled, which tests are most appropriate, how often imaging or labs should be performed, and how long surveillance should continue after initial treatment. The lack of explicit timelines and test choices can hinder consistent practice and complicate shared decision-making between clinicians and patients.
Why Specific Guidance Matters
After curative therapy, survivors rely on follow-up care to detect recurrence early, manage late effects of treatment, and monitor overall health. However, surveillance intensity varies widely among medical centers, and even among individual clinicians. When guidelines do not specify surveillance schedules or tests, clinicians may default to local norms or personal experience, which can lead to underuse, overuse, or misaligned care with patient preferences.
The stakes are high. Inadequate surveillance might miss a recurrence at a stage where curative options remain possible, while overly aggressive testing can expose patients to unnecessary radiation, false positives, invasive procedures, and increased anxiety. The study argues that clear, evidence-based surveillance intervals and test choices are essential to ensure consistent, patient-centered care across settings.
Implications for Clinicians and Patients
Clinicians face a challenging landscape where the goal is early detection of relapse without overwhelming patients with tests. The absence of precise recommendations for surveillance can complicate shared decision-making, especially for cancers with diverse recurrence patterns or for patients with comorbidities that affect follow-up strategies. Patients, on the other hand, seek predictable care paths that align with their values and quality-of-life considerations, including the psychological burden of ongoing surveillance.
What Could Improve Guideline Utility?
Experts suggested several avenues to enhance the practicality of NCCN surveillance guidance. These include:
- Explicit, cancer-specific surveillance schedules: who to test, what tests to use, and when to test.
- Clear duration of surveillance and milestones for transitioning to less intensive follow-up.
- Incorporation of risk-adapted approaches that tailor surveillance intensity to individual recurrence risk and treatment history.
- Transparent discussion of benefits, harms, and uncertainties associated with different surveillance strategies to support shared decision-making.
- Regular updates tied to emerging evidence, including data from survivorship cohorts and randomized trials.
Balancing Evidence, Patient Preference, and Resources
As the survivorship population grows, the call for precise surveillance guidance becomes more urgent. Health systems and clinicians must navigate the trade-offs between early detection, patient well-being, and resource allocation. The study underscores that robust, explicit recommendations can help standardize care while still allowing for individualized decisions tailored to each patient’s risk profile and life circumstances.
Looking Ahead
Researchers and patient advocates alike are urging NCCN to refine its surveillance sections with concrete, evidence-based intervals and test choices. The aim is to provide a reliable framework that clinicians can apply consistently and patients can trust, even as new data emerge. Until such guidelines are updated, clinicians may need to supplement NCCN guidance with disease-specific literature, institutional protocols, and shared decision-making conversations to optimize surveillance after curative therapy.
