STEP 6: Managing recurrent, residual or metastatic disease


Most residual or recurrent disease will be detected via routine follow-up or by the patient presenting with symptoms.


Evaluate each patient for referral to the original multidisciplinary team is appropriate. For most patients, treatment is often given with palliative rather than curative intent.

Advance care planning

Advance care planning is important for all patients but especially those with advanced disease. It allows them to plan for their future health and personal care by thinking about their values and preferences. This can guide future treatment if the patient is unable to speak for themselves.

Survivorship and palliative care

Review by a specialist palliative care team is essential. Survivorship and palliative care should be addressed and offered early. Early referral to palliative care can improve quality of life and in some cases may prolong survival. Referral should be based on need, not prognosis.


The lead clinician and team’s responsibilities include:

  • explaining the treatment intent, likely outcomes and side effects to the patient and/or carer and the patient’s GP.