Cancer follow-up guidelines review concludes little evidence that surveillance is beneficial to patients – more research needed.

In a systematic review of follow-up guidelines for 16 solid cancers, published in BMJ Oncology, researchers have made a call ‘for an increase in […] research to address the lack of evidence that surveillance is beneficial to patients and a good use of healthcare resources.’ The review, led by UM member Hannah Harrison, from the University of Cambridge, Department of Public Health and Primary Care, analysed 123 guidelines almost all of which recommended routine surveillance for recurrent disease (n=115, 93.5%). Of these guidelines, a little over half (n=59, 51.3%) recommend ‘indefinite or lifelong surveillance’ in asymptomatic individuals.

Dr Hannah Harrison

Harrison and colleagues identified two main challenges: heterogeneity in guidelines for same cancer type and vague or non-specific guidance. Researchers linked both challenges to the limited evidence that surveillance improves patient outcomes. This leads to lack of clarity in follow-up care. The authors recommend that ‘clinicians […] discuss the uncertainty around the benefits of many surveillance protocols with their patients to promote informed decision making.’

An accompanying editorial, ‘Surveillance imaging: minimal evidence and forgotten harms’, amplifies Harrison et al.’s conclusion that evidence supporting surveillance recommendations is weak and that the potential harms to patients are not considered in guidelines. The editorial argues that few studies have considered the patient perspective on radiological surveillance, citing two such studies that have identified harms in this type of follow-up. The editorial concludes, ‘[t]his important paper […] should serve as impetus for investment and research into surveillance imaging practices in order to improve survivorship care.’

Joint senior author and UMVI Lead, Grant Stewart said, ‘this review has demonstrated the need for investment in research to ensure that cancer follow-up after surgical removal is evidence-based and patient-centred. The economic cost and, more importantly, the anxiety and potential risk for patients, both highlighted in the accompanying BMJ Oncology editorial, should make this a research priority in the field.’

Hannah Harrison and Juliet Usher-Smith, also from the Department of Public Health and Primary Care, are now leading a study assessing a new online tool to improve communication of surveillance for patients with localised kidney cancer. The research team hope that this will lead to further studies in this important patient group.  

Hannah Harrison, Bhumi K Shah, Faris Khan, Carley Batley, Chiara Re, Sabrina H Rossi, Georgia Stimpson, Eamonn Gilmore, Eleanor White, Sofia Kler-Sangha, Aufia Espressivo, Z Sienna Pan, Tanzil Rujeedawa, Benjamin W Lamb, Laura Succony, Shi Lam, Bincy M Zacharia, Rebecca Lucey, Alexander J P Fulton, Dimana Kaludova, Anita Balakrishnan, Juliet A Usher-Smith, Grant D Stewart - 'A systematic review comparing surveillance recommendations for the detection of recurrence following surgery across 16 common cancer types': https://doi.org/10.1136/bmjonc-2024-000627 BMJ Oncology 2025;4:e000627.

Haydee Verduzco-Aguirre, Christopher M Booth, Brooke E Wilson - 'Surveillance imaging: minimal evidence and forgotten harms': https://doi.org/10.1136/bmjonc-2024-000724 BMJ Oncology 2025;4:e000724.