Colon Cancer Patients Not Getting Recommended Follow-Up Care

Click here to view as PDF.

A new study shows that less than one half of older patients successfully treated for colorectal cancer receive the recommended screening schedule to detect any recurrence of cancer. The analysis indicates poor compliance with recommended monitoring of colorectal cancer survivors could affect survival.

Patients who undergo surgery for colorectal cancer have an increased risk of recurrence. To reduce that risk, guidelines specify a combination of regularly scheduled physician visits, colonoscopy, and other tests to detect changes that could indicate a recurrence.

While some patients may not receive these recommended services, others may undergo other procedures, such as computerized tomography (CT) and positron emission tomography (PET) scanning, which are generally not recommended. Therefore, care for some patients may not meet guideline standards while others receive testing that goes beyond guideline recommendations.

Since compliance with follow-up guidelines has not been well studied, Gregory S. Cooper, MD, of University Hospitals Case Medical Center in Cleveland and his colleagues analyzed information from the Surveillance, Epidemiology and End Results (SEER) program of cancer registries and Medicare claims. They assessed overall adherence to guidelines as well as differences across patient subgroups, making this study the first known national, population-based study in the United States to examine adherence to published guidelines.

A total of 9,426 patients over age 65 who were diagnosed with adenocarcinoma of the colon or rectum were included in the analysis. Patients were followed for three years after diagnosis. The study investigators considered the screening guidelines to be fulfilled if a patient received two or more office visits per year, two or more carcinoembryonic antigen (CEA) tests per year, and at least one colonoscopy within three years.

Overall, 60% of patients received testing below recommended levels, and fewer than one in five (17.1%) received testing at the recommended frequency. Nearly one in four (22.7%) received follow-up services above those specified by screening guidelines. The researchers say that while some of the differences could be explained by clinical factors, such as stage of disease, they also found important differences across racial groups and region. The researchers say the generally lower use of testing in African Americans is likely a contributing factor to the known poorer stage-specific survival compared with whites. In addition, geographic differences across SEER sites suggest that patient and physician preferences may influence choice of testing.

“Further studies should ascertain the reasons for poor compliance and the effect on patient outcome,” the authors wrote.

Cooper GS, Tzuyung DK, Reynolds HL Jr. Receipt of guideline-recommended follow-up in older colorectal cancer survivors: A population- based analysis.

Published online: September 8, 2008.

Cancer.

Adapted from materials provided by American Cancer Society.