TOPLINE:

A review of National Comprehensive Cancer Network (NCCN) guidelines found that most surveillance recommendations were based on low-level evidence and often ambiguous about frequency, duration, and patient-specific modifications.

METHODOLOGY:

• Cancer surveillance aims to detect recurrence after curative treatment, but existing evidence shows no survival benefit from routine follow-up. Although concerns about an unfavorable risk-benefit balance have increased, the scope of US surveillance recommendations remains poorly defined.
• To address this gap, researchers systematically reviewed the NCCN Clinical Practice Guidelines in Oncology for solid organ cancers in adults between June and July 2025.
• Two reviewers independently extracted surveillance recommendations after definitive treatment, excluding metastatic or recurrent disease settings. They classified recommendations by stratification (stage, risk, or treatment), modality (imaging, laboratory, or examination), frequency, duration, and individualization.

TAKEAWAY:

• The researchers found 483 recommendations across 99 cancer types. Nearly all, 93%, were assigned category 2A evidence, indicating lower-level evidence with uniform consensus.
• Overall, 68% of recommendations were stratified by stage, treatment, or a combination of factors but only 24% called for individualizing surveillance to patient-specific factors (measuring a tumor marker only when initially elevated, for example).
• Nearly half of the recommendations (46%) were for imaging, mostly using cross‑sectional modalities; 23% advised laboratory tests, while 22% called for history and physical examinations, 6% for endoscopy, and 3% for pathology testing.
• Most recommendations (70%) offered guidance on testing frequency but often lacked specifics: 64% suggested frequency as a range, and 64% suggested lengthening surveillance intervals over time, whereas the remaining 36% offered no guidance on long-term adaptations. Regarding duration, 48% of all recommendations defined an endpoint for monitoring, while just as many deferred to clinical judgment or left duration unspecified; 3% recommended indefinite surveillance or continuation until cancer progression.

IN PRACTICE:

The ambiguity of existing guidelines “leaves significant room for interpretation, likely contributing to variation in clinical practice and the potential for both overmonitoring and undermonitoring,” the authors wrote. They suggest several solutions, such as including clinical parameters based on the best available evidence to more clearly guide surveillance intensity.

SOURCE:

The study, led by Alison Baskin, MD, of the University of California San Francisco, was published online in JAMA Network Open.

LIMITATIONS:

The study focused on NCCN guidelines and did not evaluate recommendations from professional societies such as the American Society of Clinical Oncology.

DISCLOSURES:

Baskin reported receiving grants from the National Cancer Institute and Association for Academic Surgery/Association for Academic Surgery Foundation during the conduct of the study. Two other authors disclosed receiving grants from the National Cancer Institute during the conduct of this study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.