Quality standard

Quality statement 4: Follow-up for detecting local recurrence and distant metastases

Quality statement 4: Follow-up for detecting local recurrence and distant metastases

Quality statement

Adults who have had potentially curative surgical treatment for non-metastatic colorectal cancer have follow-up for the first 3 years to detect local recurrence and distant metastases. [2012, updated 2022]

Rationale

Following up adults in the first 3 years after they have had potentially curative surgical treatment for non-metastatic colorectal cancer can help detect and treat recurrences at the earliest stage. Recurrent disease is more likely to be resectable when there is regular follow-up, compared with minimal or no follow-up.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults who have had potentially curative surgery for non-metastatic colorectal cancer have follow-up tests for the first 3 years after treatment.

Data source: No routinely collected national data has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example written surveillance protocols.

Process

a) Proportion of adults who had potentially curative surgery for non-metastatic colorectal cancer who had 6-monthly serum carcinoembryonic antigen (CEA) measurement in the 3 years after potentially curative surgery.

Numerator – the number in the denominator who had 6-monthly serum CEA measurement in the 3 years after potentially curative surgery.

Denominator – the number of adults who had potentially curative surgery for non-metastatic colorectal cancer.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Proportion of adults who had potentially curative surgery for non-metastatic colorectal cancer who had at least 2 CT scans of the chest, abdomen and pelvis in the 3 years after potentially curative surgery.

Numerator – the number in the denominator who had at least 2 CT scans of the chest, abdomen and pelvis in the 3 years after potentially curative surgery.

Denominator – the number of adults who had potentially curative surgery for non-metastatic colorectal cancer.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

c) Proportion of adults who had potentially curative surgery for non-metastatic colorectal cancer who had a clearance colonoscopy within 1 year of their diagnosis.

Numerator – the number in the denominator who had a clearance colonoscopy within 1 year of their diagnosis.

Denominator – the number of adults who had potentially curative surgery for non-metastatic colorectal cancer.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Proportion of adults with newly diagnosed locally recurrent colorectal cancer after potentially curative surgery for non-metastatic colorectal cancer whose recurrent cancer was resectable at diagnosis.

Numerator – the number in the denominator whose recurrent cancer was resectable at diagnosis.

Denominator – the number of adults with newly diagnosed locally recurrent colorectal cancer after potentially curative surgery for non-metastatic colorectal cancer.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (such as laboratory services, secondary care services and tertiary care centres) ensure that systems are in place for adults who have had potentially curative surgery for non-metastatic colorectal cancer to have follow-up testing, including serum CEA, CT scan and colonoscopy, in the first 3 years after potentially curative surgery.

Healthcare professionals (such as colorectal cancer nurse specialists) are aware of local pathways and clinical protocols for follow-up of adults who have had potentially curative surgery for non-metastatic colorectal cancer. They ensure that these adults have regular testing of serum CEA, CT scans and colonoscopy in the first 3 years after potentially curative surgery.

Commissioners (such as clinical commissioning groups, integrated care systems and NHS England) ensure that they commission services that provide regular follow-up of adults after potentially curative surgery for colorectal cancer, including measurement of serum CEA, CT scan and colonoscopy.

Adults with colorectal cancer that has not spread to other parts of their body and who have had surgery that may cure their cancer have regular check-ups and investigations for the first 3 years to check for signs that the cancer has returned or has spread.

Source guidance

The frequency of measurement of CEA, CT scan and colonoscopy used in process measures a), b) and c) are considered practical measures to enable cancer networks to measure performance. The frequencies in process measures a) and b) are taken from NICE's guideline on colorectal cancer, evidence review E1. The frequency for colonoscopy in process measure c) is used in BSG/ACPGBI/PHE post-polypectomy and post-colorectal cancer resection surveillance guidelines (2020), page 207.

Definitions of terms used in this quality standard

Follow-up to detect local recurrence and distant metastases

Follow-up includes measurement of serum CEA at least every 6 months and a minimum of 2 CT scans of the chest, abdomen and pelvis in the first 3 years. Clearance colonoscopy should be done within a year of diagnosis. [Adapted from NICE's guideline for colorectal cancer, recommendation 1.6.1 and evidence review E1 and BSG/ACPGBI/PHE post-polypectomy and post-colorectal cancer resection surveillance guidelines (2020), page 207]