Many colon cancer patients skip follow-up care

NEW YORK (Reuters Health) - The results of new research indicate that many older patients who survive colorectal cancer do not attend the guideline-recommended follow-up office visits or undergo carcinoembryonic antigen (CEA) testing and colonoscopy.

"The current study is the first known national, population-based study in the U.S. to examine actual adherence to published comprehensive guidelines. The study included patients cared for in diverse practice settings and by different specialists," lead author Dr. Gregory S. Cooper told Reuters Health.

"The biggest finding was the low rate of guideline adherence, with approximately 60 percent receiving less than the recommended care and, in contrast, 20 percent received care in excess of guidelines," according to Cooper, a gastroenterologist with University Hospitals Case Medical Center in Cleveland, Ohio. "All patients were insured under Medicare, so lack of insurance cannot be a factor."

Using a linked tumor registry-claims database, the researchers identified 9,426 patients, 66 years of age or older, who were observed for 3 years following diagnosis and treatment of colorectal cancer in 2000 to 2001. The subjects were classified as receiving recommended follow-up if they had at least two office visits per year; at least two CEA tests per year in the first 2 years; and at least one colonoscopy performed within 3 years.

Overall, 60.2 percent of the patients received follow-up below recommended levels and 22.7 percent received excessive follow-up, according to the report in the journal Cancer. Thus, just 17.1 percent of patients received follow-up at the recommended frequency.

Guideline adherence ranged from 92.3 percent for office visits to 46.7 percent for CEA testing, while 73.6 percent of patients underwent recommended colonoscopy.

Although not recommended, abdominal/pelvic CT was performed in 47.7 percent of patients and PET scan was performed in 6.8 percent.

Adherence to follow-up guidelines was more likely in patients who were younger, white and had regional-stage malignancies and poorly differentiated tumors, the report indicates. The findings also indicate there was significant variation in guideline adherence by geographic location. This suggests that local practice patterns play a role in receipt of recommended follow-up, Dr. Cooper noted.

"Routine surveillance has been shown to improve survival after potentially curative treatment of colorectal cancer," Cooper said. "Assuming that the patient would benefit from early detection of recurrence, the use of these procedures should be encouraged. As some of these patients may be receiving their care from primary care physicians alone, primary providers should also be aware of guidelines."

SOURCE: Cancer, October 15, 2008.