A 75-year-old man returns for his fourth CT scan in five years after complete removal of a low-risk renal tumor. Each time, the result is unchanged: no recurrence. Yet the cycle of imaging, radiation exposure, and anxiety persists. His story reflects a wider question in oncology: how much follow-up imaging truly benefits low-risk patients, and at what cost?
Shifting from routine to value-based imaging
The Dutch initiative “NierKompas,” led by CCA’s Dr. Patricia Zondervan and PhD candidate Luuk de Haan, tackles this issue within the national “Zorgevaluatie en Gepast Gebruik” (ZE&GG) program, supported by a “Less is More” grant. The project aims to reduce low-value care—interventions that lack robust evidence, add minimal benefit, and may provoke unnecessary downstream testing.
In Less is More projects, clinical guidelines are revised proactively rather than waiting for prospective trials. This is feasible because many guideline recommendations are still based on expert opinion or established practice, even though real-world experience shows that some of these interventions provide limited or no added value.
Prospective studies to evaluate such care are often impractical due to long timelines, high costs, and the large patient populations required. By more rapidly removing unproven care from guidelines, healthcare delivery can be made more efficient and appropriate. An example is the follow-up strategy after treatment for low-risk kidney cancer.
Re‑designing follow-up in low-risk RCC
The Netherlands sees around 2,700 new kidney cancer cases annually. Many tumors are detected early, are relatively indolent, and carry a low recurrence risk. Retrospective data show that low-risk patients face about an 8% chance of recurrence within five years. Nevertheless, current guidelines advise at least four CT scans of chest and abdomen in that period.
Most large European studies show that more frequent scanning does not improve survival. If this type of cancer returns, it is usually not detected during a scheduled scan, but because a patient develops symptoms.
Amsterdam UMC therefore brought together a national working group of urologists, a radiologist, researchers and a patient representative. Based on scientific evidence and practical experience, the group developed a new follow-up schedule with fewer scans, without compromising patient safety. Under the new schedule, patients receive two CT scans instead of four: one after two years and one after five years.
Embedded prospective evaluation
In addition to revising and implementing the Dutch guideline, NierKompas adds something more. It wants to evaluate whether this change actually works: whether the new follow-up is safe, whether the protocol is applied in practice, PROMs, and what benefit is achieved with it. To assess this, theresearchers prospectively monitor and evaluate the change within PRO-RCC (Stichting PRO-RCC), the national registry for kidney cancer patients.
Benefit for both patient and hospital
The expected annual avoidance of 1,900 CT scans translates into an estimated reduction of 17.5 tons of CO₂ and €440,000 in healthcare costs, alongside reduced radiation exposure and fewer hospital visits for patients.
The medical protocol was finalized in February 2026; guideline adaptation is anticipated in December 2026, with national implementation from 1 January 2027.