Cancer guidelines after active treatment have low specificity, consistency

In a retrospective cross-sectional analysis, a group of researchers examined the specificity and consistency of recommendations for cancer surveillance after effective treatment across guidelines.

The findings, published in the Journal of the American Medical Association, identified 41 guidelines that addressed post-treatment care for survivors of the nine most common cancers. The researchers categorized surveillance modalities into history and physical examinations, tumor markers, diagnostic procedures and imaging. Individual recommendations were then classified into five different categories.

“We reviewed each surveillance recommendation for frequency and a stop date, evaluated consistency among guidelines and analyzed associations between the organizations proposing the guidelines and recommendation characteristics,” wrote Ryan P. Merkow, MD, MS, of the Memorial Sloan Kettering Cancer Center in New York, and co-authors.

Data suggests that 83 percent of the guidelines had ambiguous recommendations, and 44 percent recommended against at least one test. Recommendations commonly specified testing frequency, but they rarely suggested a definitive stop time. Researchers also found that cross-sectional imaging recommendations varied among guidelines for each cancer.

“Guidelines addressing the care of cancer survivors have low specificity and consistency,” the authors wrote. “As guidelines continue to be revised, developers should clarify recommendations with simple, unambiguous, definitive language for or against the use of specific tests to optimize care quality and resource utilization.”