Follow-up after surgery for colorectal cancer: the FUTURE-primary implementation study

The FUTURE-primary study is a multicentre prospective regional implementation study of a patient-led home-based follow-up
approach after curative treatment for colorectal cancer treatment. Follow-up will be carried out for up to five years after surgery.
Follow-up will be performed in accordance with the current Dutch national guidelines. Blood sampling will in principle be performed
at home, while the actual CEA measurements will be centralized and interpretation of the results will be done by the treating
physician in the participating centre (the centre where the initial treatment was performed). Blood sampling is planned every six
months during the first two years after inclusion and yearly thereafter. One year after surgery medical imaging (according to local
practices) and clinical evaluation will be scheduled. In hospital evaluation will only be performed in case of abnormal CEA values or
if desired by the patient (in case of normal CEA levels). Subsequent use of medical imaging is used according to national guidelines
and local practices. The frequency of patient-initiated CEA measurements and in-hospital evaluations cannot exceed the maximum
amount of the current Dutch national guidelines unless clinically indicated (e.g. CEA increase or symptoms). The Dutch national
guidelines advise CEA measurements every three months during the first two years and every six months thereafter. The desired
frequency can be changed by the patient at any time.

We hypothesize that a patient-led home-based follow-up can be implemented successfully. In addition, we hypothesize that such an approach improves quality of life outcomes and reduces anxiety and fear of cancer recurrence when compared with the contemporary in-hospital approach.

All of the retrospective questionnaires, with the exception of the ASC-CW, will be completed at baseline and every 6 months thereafter in the first three years, in the last 2 years the questionnaires will be completed annually or when patients leave the study due to disease recurrence. The ASC-CW scale will be completed once at 12 months following inclusion and in case of no disease recurrence. The ecological momentary assessment of momentary quality of life will be performed for the entire duration of the study, regardless of disease recurrence.