Receipt of recommended surveillance among colorectal cancer survivors: a systematic review

Abstract

Purpose Regular surveillance decreases the risk of recurrent cancer in colorectal cancer (CRC) survivors. However, studies suggest that receipt of follow-up tests is not consistent with guidelines. This systematic review aimed to: (1) examine receipt of recommended post-treatment surveillance tests and procedures among CRC survivors, including adherence to established guidelines, and (2) identify correlates of CRC surveillance. Methods Systematic searches of Medline, PubMed, PsycINFO, CINAHL Plus, and Scopus databases were conducted using terms adapted for each database’s keywords and subject headings. Studies were screened for inclusion using a 3-step process: (1) lead author reviewed abstracts of all eligible studies; (2) coauthors reviewed random 5% samples of abstracts; and (3) two sets of coauthors reviewed all “maybe” abstracts. Discrepancies were adjudicated through discussion. Results Thirty-four studies are included in the review. Overall adherence ranged from 12–87%. Within the initial 12 to 18 months post-treatment, adherence to recommended office visits was 93%. Adherence ranged from 78–98% for physical exams, 18–61% for colonoscopy, and 17–71% for CEA testing. By 2 to 3 years post-treatment, cumulative adherence ranged from 70–88% for office visits, 89–93% for physical exams, 49–94% for colonoscopy, and 7–79% for CEA testing. Between 18–28% of CRC survivors received greater than recommended overall surveillance; overuse of physical exams (42%), colonoscopy (24–76%), and metastatic disease testing (1–29%) was also prevalent. Studies of correlates of CRC surveillance focused on socio-demographic and disease/treatment characteristics, and patterns of association were inconsistent across studies. Conclusions Deviation from surveillance recommendations includes both under- and overuse. Examination of modifiable determinants is needed to inform interventions targeting appropriate and timely receipt of recommended surveillance.

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).…”

Examining colorectal cancer survivors’ surveillance patterns and experiences of care: a SEER-CAHPS study

“…Future research is needed to explore other reasons for avoidance, including mixed methods research aimed at unpacking both patient and provider barriers to receipt of surveillance. Conversely, another area for future research is examination of potential drivers of surveillance overutilization [39], which was not explored in the current study.…”

“…Despite recommendations, systematic reviews of factors associated with underuse of guideline-recommended posttreatment surveillance have consistently identified sociodemographic and disease/treatment factors associated with adherence to needed CRC care [4,10]. Underuse of surveillance care has been shown to be independently associated with being African American, older, having lower income, and being treated in a community setting versus academic center [10].…”

“…Underuse of surveillance care has been shown to be independently associated with being African American, older, having lower income, and being treated in a community setting versus academic center [10]. Studies on adherence to CRC surveillance have primarily focused on patient socio-demographic factors and disease/treatment characteristics [4]. While these findings are useful for identifying high-risk groups where intervention may be warranted to increase adherence, studies are lacking on potentially modifiable patient-, healthcare system-and provider-level factors, such as improving access to care and care coordination between oncology and primary care, both of which could affect patient experiences and receipt of recommended care.…”

“…National guidelines recommend that first course treatment for individuals diagnosed with American Joint Committee on Cancer (AJCC)-designated stage II and III CRC include surgical resection which may or may not be followed by chemotherapy and/ or radiation therapy [3]. Research suggests a lack of adherence to follow-up procedures per CRC guidelines [4]. Despite definitive treatment, up to 35% of these patients will experience a recurrence of their CRC within 5 years [5], making the need for continued surveillance essential.…”