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Many colorectal cancer survivors do not receive recommended follow-up care
September 08, 2008A new analysis reveals that fewer than half of older patients successfully treated for colorectal cancer receive the recommended screening schedule to detect any recurrence of cancer. The study, appearing in the October 15, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society, indicates poor compliance to recommended monitoring of colorectal cancer survivors could affect survival.
Patients who undergo potentially curative surgery for colorectal cancer have an increased risk of recurrence. To reduce that risk, guidelines have been developed that 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) scans, which are generally not recommended. Therefore, some patients may not meet guidelines standards while others receive testing that goes beyond guideline recommendations.
Because compliance with follow-up guidelines has not been well studied, Gregory S. Cooper, M.D. of University Hospitals Case Medical Center in Cleveland and 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 from 2000-2001 were included in the analysis. Patients were followed to 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, six in ten (60.2 percent) of patients received testing below recommended levels, while fewer than one in five (17.1 percent) received testing at the recommended frequency. Nearly one in four (22.7 percent) received follow-up services above those specified by screening guidelines. The researchers say that while some of the difference 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 to Caucasians. 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.
American Cancer Society
A total of 9,426 patients over age 65 who were diagnosed with adenocarcinoma of the colon or rectum from 2000-2001 were included in the analysis. Patients were followed to 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, six in ten (60.2 percent) of patients received testing below recommended levels, while fewer than one in five (17.1 percent) received testing at the recommended frequency. Nearly one in four (22.7 percent) received follow-up services above those specified by screening guidelines. The researchers say that while some of the difference 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 to Caucasians. 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.
American Cancer Society
Colorectal Cancer Current Events and Colorectal Cancer News RSSHuman genomics in China
Ten years ago, the Chinese National Human Genome Center at Shanghai (South Center, hereafter) was established in the Zhangjiang HiTech Park of Pudong District in Shanghai. To commemorate this important event, which marks the beginning of the Genomics Era in China, we specially organize a series of mini-reviews for this special issue.
Hormone therapy associated with reduced colorectal cancer risk
The combination of estrogen plus progestin, which women stopped taking in droves following the news that it may increase their risk of breast cancer, may decrease their risk of colorectal cancer, according to a report published in the January issue of Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research.
Annals colonoscopy study underscores importance of quality standards
A study by Baxter, et al. released this week and scheduled to be published in the Jan. 6, 2009, edition of Annals of Internal Medicine, concluded that while screening colonoscopy is associated with fewer deaths from colorectal cancer, the association is primarily limited to deaths from cancer developing in the left side of the colon.
ASGE urges patients to seek a qualified endoscopist before undergoing a colonoscopy
A study released today in the Annals of Internal Medicine found that colonoscopy is associated with lower death rates from colorectal cancer, however, the procedure missed lesions more often on the right side of the colon versus the left side.
CT colonography offers 1-stop screening for cancer and osteoporosis
New research reveals that computed tomography (CT) colonography, also known as virtual colonoscopy, has the potential to screen for two diseases at once-colorectal cancer and osteoporosis, both of which commonly affect adults over age 50.
Screening for colorectal cancer detects unrecognized disease
Screening for colorectal cancer detects four out of ten cancers and should be carefully designed to be more effective, according to a study published today on bmj.com.
A Simple Blood Test for Colon Cancer
People are often reluctant to undergo a routine but painful colonoscopy ― but the consequences can be fatal. According to the American Cancer Society, colon cancer is the third most common cancer found in American men and women and kills about 50,000 Americans every year.
New platinum-phosphate compounds kill ovarian cancer cells
A new class of compounds called phosphaplatins can effectively kill ovarian, testicular, head and neck cancer cells with potentially less toxicity than conventional drugs, according to a new study published this week in the journal Proceedings of the National Academy of Sciences.
Survival of head and neck cancer patients is greatly affected by coexisting ailments
Current estimates for head and neck cancer survival are largely inaccurate because they widely disregard many of the most common diseases such patients have in addition to their primary cancer, says Jay Piccirillo, M.D., a head and neck specialist at Washington University School of Medicine in St. Louis, the Siteman Cancer Center and Barnes-Jewish Hospital.
Home-based diet and exercise intervention improves elderly cancer survivors' physical function
A home-based program to improve exercise and diet led to significant, clinically meaningful improvement in body weight and physical function among older long-term cancer survivors in preliminary findings from the RENEW (Reach-out to ENhancE Wellness) trial.
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