Colorectal cancer follow‐up

Dear Sir, Having spent nearly a decade attempting to streamline the stages of diagnosis and immediate care of patients with colorectal cancer, the Cancer Services Collaborative ⁄ NHS Improvement Group under Prof. Mike Richards is moving on to embrace ‘Survivorship’. In common parlance, this is what happens for patients once their initial treatment has been finalized and follow up or extended follow up commences. It starts when patients are ‘signed off’ their cancer multidisciplinary team (MDT) and ends with either cancer death or cure. At our first meeting of Clinical Leads, we wondered how good we might currently be in our own MDTs at specifying the type of follow up that we were recommending, and also whether we are documenting these decisions. At Leicester General Hospital, we have reviewed the ‘sign-off statements’ on our database for all the patients whom we discussed during April 2008 to March 2009. We discussed 269 patients, of whom one died before any follow-up policy could be formulated. Of the remaining 268 patients, the majority were allocated to our agreed 5-year surveillance schedule of specified clinic follow up, scans and endoscopy. For 180 (67%) patients, the mode of follow up was clearly specified (Table 1); for 43 (16%), it was implied but not overtly stated (Table 2) and for 45 (17%), no follow-up plan was recorded by our MDT. Table 3 relates follow up to treatment type, and it is clear that we are much more specific in specifying followup type when there is a therapeutic or palliative plan compared with when we are uncertain. As all our MDT sign-off statements are sent in the form of a letter to the patient’s GP and other relevant parties, we have provided either a definite or an implied follow-up plan in 223 ⁄ 268 (83%) of our patients. We wonder whether this is a reasonable benchmark number, or whether others are doing rather better.