Risk-stratified follow-up: low-risk survivors to primary care with fast re-entry

Overview

• Protocol upgrade, graded proven but unevenly used, with moderate evidence. In breast cancer, the Cochrane review of five trials with 4,023 women found no survival difference between intensive testing and follow-up by clinical visits and mammography (hazard ratio 0.98), and no difference in survival or time to detection of recurrence between follow-up by a hospital specialist and by a general practitioner, with greater satisfaction in general practice. In colorectal cancer, 19 studies with 13,216 participants found intensive follow-up made little or no difference to overall survival (hazard ratio 0.91) but doubled salvage surgery with curative intent (risk ratio 1.98), which is why stratified pathways keep scheduled surveillance tests while removing routine clinic visits. OnCo found no national measure of how many survivors are on a stratified pathway.