Recommendations from German and international guidelines on long-term survivorship care after cancer: A scoping review and evidence maps.

BACKGROUND

Advances in cancer detection and treatment have resulted in a growing population of survivors. Many face long-term physical, psychological, and financial challenges that are unevenly distributed across socioeconomic, racial, and demographic groups. Clinical guidelines should provide recommendations to guide survivorship care and ensure equity.

OBJECTIVE

To provide an overview of recommendations from existing guidelines addressing follow-up care after cancer.

METHODS

International and German clinical guidelines were identified through a systematic search of MEDLINE, TRIP, GuidelineCentral, NICE, G-I-N and SIGN, complemented by manual searches of relevant registries (AWMF, Onkopedia, ESMO, IGHG). Guidelines were included if they contained at least one recommendation on follow-up or survivorship care. Screening was performed independently by two reviewers. Recommendations were coded using a predefined framework and synthesized using tables and interactive evidence-maps.

RESULTS

198 guidelines comprising 2270 recommendations were included. The most frequently represented categories were cross-sectional guidelines (i.e., not limited to a specific cancer type) (n = 36), followed by gastrointestinal tumors (n = 15) and myeloid proliferations (n = 14); most targeted adults (n = 150). Of all recommendations, 39% were evidence-based. Frequently addressed topics included previous treatment (n = 342), long-term survivorship (>5 years) (n = 705), screening for adverse events (n = 263), timing of follow-up (n = 338), and counselling and education (n = 234). The extent to which recommendations explicitly addressed equity-related factors varied considerably: age was frequently considered (n = 160), whereas socioeconomic status (n = 18), race/ethnicity (n = 5), and religion/culture (n = 6) were rarely addressed.

CONCLUSION

Survivorship care was addressed heterogeneously across guidelines, with long-term and equity aspects underrepresented. More consistent, evidence-based and equity-oriented guideline development is needed.