Berian Julia R, Cuddy Amanda, Francescatti Amanda B, O'Dwyer Linda, Nancy You Y, Volk Robert J, Chang George J
Division of Research and Optimal Patient Care, American College of Surgeons, 633 N. St Clair St., 22nd Floor, Chicago, IL, 60611, USA.
Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
J Cancer Surviv. 2017 Oct;11(5):542-552. doi: 10.1007/s11764-017-0623-2. Epub 2017 Jun 22.
Surveillance after colorectal cancer (CRC) treatment is routine, but intensive follow-up may offer little-to-no overall survival benefit. Given the growing population of CRC survivors, we aimed to systematically evaluate the literature for the patient perspective on two questions: (1) How do CRC patients perceive routine surveillance following curative treatment and what do they expect to gain from their surveillance testing or visits? (2) Which providers (specialists, nursing, primary care) are preferred by CRC survivors to guide post-treatment surveillance?
Systematic searches of PubMed MEDLINE, Embase, the CENTRAL Register of Controlled Trials, CINAHL, and PsycINFO were conducted. Studies were screened for inclusion by two reviewers, with discrepancies adjudicated by a third reviewer. Data were abstracted and evaluated utilizing validated reporting tools (CONSORT, STROBE, CASP) appropriate to study design.
Citations (3691) were screened, 91 full-text articles reviewed, and 23 studies included in the final review: 15 quantitative and 8 qualitative. Overall, 12 studies indicated CRC patients perceive routine surveillance positively, expecting to gain reassurance of continued disease suppression. Negative perceptions described in six studies included anxiety and dissatisfaction related to quality of life or psychosocial issues during follow-up. Although 5 studies supported specialist-led care, 9 studies indicated patient willingness to have follow-up with non-specialist providers (primary care or nursing).
Patients' perceptions of follow-up after CRC are predominantly positive, although unmet needs included psychosocial support and quality of life.
Survivors perceived follow-up as reassuring, however, surveillance care should be more informative and focused on survivor-specific needs.
结直肠癌（CRC）治疗后的监测是常规操作，但强化随访可能对总体生存率几乎没有益处。鉴于CRC幸存者人数不断增加，我们旨在系统评估文献，以了解患者对两个问题的看法：（1）CRC患者如何看待根治性治疗后的常规监测，他们期望通过监测检查或就诊获得什么？（2）CRC幸存者更倾向于由哪些医疗服务提供者（专科医生、护士、初级保健医生）来指导治疗后的监测？
对PubMed MEDLINE、Embase、Cochrane对照试验中心注册库、CINAHL和PsycINFO进行系统检索。由两名评审员筛选纳入研究，如有分歧则由第三名评审员裁决。利用适合研究设计的经过验证的报告工具（CONSORT、STROBE、CASP）提取和评估数据。
共筛选了3691篇引文，评审了91篇全文文章，最终纳入23项研究：15项定量研究和8项定性研究。总体而言，12项研究表明CRC患者对常规监测持积极看法，期望获得疾病持续得到控制的安心感。6项研究中描述的负面看法包括随访期间与生活质量或心理社会问题相关的焦虑和不满。虽然5项研究支持由专科医生主导的护理，但9项研究表明患者愿意接受非专科医疗服务提供者（初级保健医生或护士）的随访。
CRC患者对随访的看法主要是积极的，尽管未满足的需求包括心理社会支持和生活质量。
幸存者认为随访能让人安心，然而，监测护理应提供更多信息，并关注幸存者的特定需求。
