Receipt of guideline‐recommended follow‐up in older colorectal cancer survivors

Abstract

BACKGROUND After curative resection for colorectal cancer, routine follow‐up with office visits, carcinoembryonic antigen (CEA), and colonoscopy is recommended. The actual adherence to these guidelines as well as the potential overuse of testing in routine practice has not been well studied. METHODS The authors identified 9426 eligible patients aged ≥66 years in a linked tumor registry‐claims database who were diagnosed with adenocarcinoma of the colon or rectum from 2000 to 2001. Patients were observed to 3 years after diagnosis. Receipt of ≥2 office visits per year, ≥2 CEA tests per year (years 1 and 2), and ≥1 colonoscopy within 3 years constituted guideline fulfillment. RESULTS Guidelines for office visits, colonoscopy, and CEA testing were met in 92.3%, 73.6%, and 46.7% of patients, respectively. In addition, receipt of 2 nonrecommended procedures, abdominal/pelvic computed tomography scans and positron emission tomography scans, was documented in 47.7% and 6.8%, respectively. Overall, 60.2% received testing below recommended levels, 17.1% at recommended frequency, and 22.7% above guideline recommendations. In a multivariate analysis, factors associated with meeting guidelines included younger age group, white race, regional stage cancers, and poorly differentiated tumors. Considerable geographic variation in meeting guidelines was also observed. CONCLUSIONS Many older colorectal cancer survivors in this population‐based cohort underwent testing below a minimum frequency specified by clinical practice guidelines, especially with regard to CEA. Further studies should ascertain the reasons for poor compliance and the effect on patient outcome. Cancer 2008. © 2008 American Cancer Society.

Cancer survivorship: Advancing the concept in the context of colorectal cancer

“…Decision-making processes take priority during the diagnosis and treatment phases (Lynch et al, 2008b). When treatment is complete, monitoring for recurrence becomes a priority for HCP's (Brawarsky et al, 2013;Carpentier et al, 2013;Cooper et al, 2008;Esplen et al, 2007;Hu et al, 2011;Salz et al, 2009). Meanwhile, the survivor becomes preoccupied with healing, recovery, adjustment, adaption and coping processes (Appleton et al, 2013;Chambers et al, 2012b;Di Fabio et al, 2008;Esplen et al, 2007;Grant et al, 2011;Loi, 2011;McCaughan et al, 2012;Nikoletti et al, 2008;Serpentini et al, 2011).…”

Patient–Clinician Information Engagement Improves Adherence to Colorectal Cancer Surveillance after Curative Treatment: Results from a Longitudinal Study

“…The criteria for adherence were adopted from Cooper and colleagues [6], and being adherent was defined as having received all the following: (a) two or more office visits or physical examinations in the last year, (b) two or more CEA tests in the last year, and (c) one colonoscopy within the last year. These criteria represent a composite of the minimum level of surveillance procedures consistent with the prevailing recommended procedures in 2005 that were common across major professional societies (e.g., the American Society of Clinical Oncology We assessed participants' frequency of undergoing cancer surveillance procedures by asking participants in round 2: "How often have you done the following things in the past 12 months, as part of your routine cancer follow-up?…”

“…We noted that ASCO and NCCN recommended annual abdominal CT scans for patients with a higher risk for recurrence (i.e., those with lymphatic or venous invasion or poorly differentiated tumors) in their guidelines for 2005 and that some health care providers were likely to have performed CT imaging as part of routine surveillance of CRC patients [6,9]. However, annual CT was not uniformly recommended by the different professional societies at the time of round 2 data collection in this study.…”

“…Studies showed that ethnicity, income, age, and cancer stage were associated with a greater likelihood of receiving surveillance testing according to recommended guidelines. For instance, studies based on the Surveillance, Epidemiology, and End Results (SEER)-Medicare database reported that CRC patients who were younger, were white, had regional stage cancers, or had poorly differentiated tumors were more likely to adhere to guideline-recommended surveillance testing [6,11]. Research in a managed care setting showed that CRC patients who were white or lived in neighborhoods with higher median household incomes were more likely to undergo colon examination and CEA testing [9].…”

S3-Leitlinie – Kolorektales Karzinom

“…Lebensjahres nur in 73,6 % der Fälle die empfohlenen Koloskopien und lediglich bei 46,7 % eine Bestimmung des CEA erfolgte, während nicht empfohlene Maßnahmen wie CT und PET-CT bei 48 bzw. 7 % durchgeführt wurden [1261].…”