Surveillance following treatment for colorectal cancer in Australia. Has best practice been adopted by medical oncologists?

• Published in: Internal medicine journal Vol. 38; no. 6a; pp. 415 - 421
• Main Authors: Kosmider, S., Field, K., Jefford, M., Jennens, R., Gibbs, P.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01-06-2008
• Subjects: Australia - epidemiology; Biomarkers, Tumor - blood; Carcinoembryonic Antigen - blood; Clinical Competence; colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - therapy; Combined Modality Therapy; Diagnostic Imaging - methods; Humans; Medical Oncology - methods; Morbidity; Population Surveillance - methods; Prognosis; Retrospective Studies; surveillance; survey; Australia
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/j.1445-5994.2007.01482.x

Background:  Intensive follow up after surgery for colorectal cancer is associated with a significant survival advantage and is endorsed by expert panels, but are physicians convinced of the benefit?
Methods:  A questionnaire was mailed to all members of the Medical Oncology Group of Australia, assessing surveillance practices after completion of adjuvant treatments.
Results:  Responses were obtained from 141 (55%) medical oncologists of which 121 were considered evaluable. Thirteen per cent (n = 16) routinely did not carry out follow‐up investigations. Of those carrying out surveillance, 47% (n = 51) nominated identifying potentially resectable metastatic disease as prime consideration. Many (44%) were motivated by patient reassurance and expectation. Carcinoembryonic antigen levels were commonly monitored 3 monthly in years 1 (77%, n = 85) and 2 (57%, n = 63) and 6 monthly thereafter (67%, n = 74). Eighty per cent (n = 88) carried out computed tomography (CT) surveillance 1 year after surgery, 69% (n = 76) at year 2 and 55% (n = 60) at year 3. Twenty‐six per cent (n = 29) continued scanning annually up to 5 years. Inclusion of CT chest was routine for 33% (n = 36) and never carried out by 11% (n = 12).
Conclusion:  A significant minority (13%) of oncologists carry out no follow‐up investigations, despite level I evidence of a survival advantage similar to standard adjuvant therapies. Further education and study of physician attitudes and reservations to routine surveillance are required.