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 2,270 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.