Follow-Up Care Falls Short After Colorectal Cancer Surgery

ORLANDO — Most colorectal cancer patients who undergo potentially curative resection of their tumors after age 65 do not receive the follow-up care that is recommended in clinical practice guidelines, according to the results of a large, population-based study.

Follow-up fell short in 74% of survivors, with the greatest lapse seen in carcinoembryonic antigen (CEA) testing, which is done to detect recurrent colon cancer.

Just 30% of survivors had their CEA concentrations measured twice a year, Dr. Gregory S. Cooper reported at a meeting on gastrointestinal cancers sponsored by the American Society of Clinical Oncology.

Dr. Cooper of University Hospitals Case Medical Center, Cleveland, mined the linked Surveillance Epidemiology and End Results (SEER)-Medicare database to obtain the information used in the study.

He and his colleagues analyzed data on a total of 9,246 patients older than 65 years with local or regional colorectal cancer that was diagnosed in 2000 and 2001. All of the patients had their cancer resected with curative intent. The mean age of the patients was 77 years; 55% were female, and 87% were white.

About 76% of the tumors were located in the colon, and the remainder were located in the rectum. Likewise, 60% of cancers were local and the rest were regional. Patients who died within 3.5 years of diagnosis were excluded, as were those diagnosed with carcinoma in situ.

Medicare claims identified procedures performed between 6 and 42 months after diagnosis. These included office visits, colonoscopy, CT or PET scans, and CEA testing.

Patients were deemed to have been treated according to American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines if they had at least two office visits per year, at least two CEA tests per year, at least one colonoscopy within 3 years of their resection, and a yearly CT scan for any poorly differentiated cancer.

Patients were judged to be treated in excess of the guidelines if they had CT scans for tumors that were not poorly differentiated and if they had PET scans, which are not routinely recommended.

Dr. Cooper and his colleagues found just 30% of patients had the requisite testing for CEA; 74% had a colonoscopy within 3 years, and 90% had office visits according to the recommended schedule. Forty-eight percent had CT scans, only half of which were done for poorly differentiated cancer. Seven percent had PET scans.

In all, 74% of patients failed to get the follow-up care that the guidelines recommended, 16% received care that exceeded the guidelines, and only 10% received care that met the guidelines. Patients tended to get appropriate care if they were younger, female, and had lymph node involvement at diagnosis. Older patients were less likely to receive follow-up care in accordance with the guidelines.

“This bias might have been physician driven, where the physician feels that the patient is very [elderly], and so what are they going to do with the information if they find a recurrence,” Dr. Cooper suggested in an interview at the symposium.

There also was some geographic variation in adherence to the guidelines, with the West coast being less compliant than the East coast, he said.

The study was supported by the American Cancer Society. Dr. Cooper said he had no conflicts of interest to disclose.

Just 30% of patients had the requisite testing for CEA, and only 74% had a colonoscopy within 3 years. DR. COOPER

ORLANDO — Most colorectal cancer patients who undergo potentially curative resection of their tumors after age 65 do not receive the follow-up care that is recommended in clinical practice guidelines, according to the results of a large, population-based study.

Follow-up fell short in 74% of survivors, with the greatest lapse seen in carcinoembryonic antigen (CEA) testing, which is done to detect recurrent colon cancer.

Just 30% of survivors had their CEA concentrations measured twice a year, Dr. Gregory S. Cooper reported at a meeting on gastrointestinal cancers sponsored by the American Society of Clinical Oncology.

Dr. Cooper of University Hospitals Case Medical Center, Cleveland, mined the linked Surveillance Epidemiology and End Results (SEER)-Medicare database to obtain the information used in the study.

He and his colleagues analyzed data on a total of 9,246 patients older than 65 years with local or regional colorectal cancer that was diagnosed in 2000 and 2001. All of the patients had their cancer resected with curative intent. The mean age of the patients was 77 years; 55% were female, and 87% were white.

About 76% of the tumors were located in the colon, and the remainder were located in the rectum. Likewise, 60% of cancers were local and the rest were regional. Patients who died within 3.5 years of diagnosis were excluded, as were those diagnosed with carcinoma in situ.

Medicare claims identified procedures performed between 6 and 42 months after diagnosis. These included office visits, colonoscopy, CT or PET scans, and CEA testing.

Patients were deemed to have been treated according to American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines if they had at least two office visits per year, at least two CEA tests per year, at least one colonoscopy within 3 years of their resection, and a yearly CT scan for any poorly differentiated cancer.

Patients were judged to be treated in excess of the guidelines if they had CT scans for tumors that were not poorly differentiated and if they had PET scans, which are not routinely recommended.

Dr. Cooper and his colleagues found just 30% of patients had the requisite testing for CEA; 74% had a colonoscopy within 3 years, and 90% had office visits according to the recommended schedule. Forty-eight percent had CT scans, only half of which were done for poorly differentiated cancer. Seven percent had PET scans.

In all, 74% of patients failed to get the follow-up care that the guidelines recommended, 16% received care that exceeded the guidelines, and only 10% received care that met the guidelines. Patients tended to get appropriate care if they were younger, female, and had lymph node involvement at diagnosis. Older patients were less likely to receive follow-up care in accordance with the guidelines.

“This bias might have been physician driven, where the physician feels that the patient is very [elderly], and so what are they going to do with the information if they find a recurrence,” Dr. Cooper suggested in an interview at the symposium.

There also was some geographic variation in adherence to the guidelines, with the West coast being less compliant than the East coast, he said.

The study was supported by the American Cancer Society. Dr. Cooper said he had no conflicts of interest to disclose.

Just 30% of patients had the requisite testing for CEA, and only 74% had a colonoscopy within 3 years. DR. COOPER

ORLANDO — Most colorectal cancer patients who undergo potentially curative resection of their tumors after age 65 do not receive the follow-up care that is recommended in clinical practice guidelines, according to the results of a large, population-based study.

Follow-up fell short in 74% of survivors, with the greatest lapse seen in carcinoembryonic antigen (CEA) testing, which is done to detect recurrent colon cancer.

Just 30% of survivors had their CEA concentrations measured twice a year, Dr. Gregory S. Cooper reported at a meeting on gastrointestinal cancers sponsored by the American Society of Clinical Oncology.

Dr. Cooper of University Hospitals Case Medical Center, Cleveland, mined the linked Surveillance Epidemiology and End Results (SEER)-Medicare database to obtain the information used in the study.

He and his colleagues analyzed data on a total of 9,246 patients older than 65 years with local or regional colorectal cancer that was diagnosed in 2000 and 2001. All of the patients had their cancer resected with curative intent. The mean age of the patients was 77 years; 55% were female, and 87% were white.

About 76% of the tumors were located in the colon, and the remainder were located in the rectum. Likewise, 60% of cancers were local and the rest were regional. Patients who died within 3.5 years of diagnosis were excluded, as were those diagnosed with carcinoma in situ.

Medicare claims identified procedures performed between 6 and 42 months after diagnosis. These included office visits, colonoscopy, CT or PET scans, and CEA testing.

Patients were deemed to have been treated according to American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines if they had at least two office visits per year, at least two CEA tests per year, at least one colonoscopy within 3 years of their resection, and a yearly CT scan for any poorly differentiated cancer.

Patients were judged to be treated in excess of the guidelines if they had CT scans for tumors that were not poorly differentiated and if they had PET scans, which are not routinely recommended.

Dr. Cooper and his colleagues found just 30% of patients had the requisite testing for CEA; 74% had a colonoscopy within 3 years, and 90% had office visits according to the recommended schedule. Forty-eight percent had CT scans, only half of which were done for poorly differentiated cancer. Seven percent had PET scans.

In all, 74% of patients failed to get the follow-up care that the guidelines recommended, 16% received care that exceeded the guidelines, and only 10% received care that met the guidelines. Patients tended to get appropriate care if they were younger, female, and had lymph node involvement at diagnosis. Older patients were less likely to receive follow-up care in accordance with the guidelines.

“This bias might have been physician driven, where the physician feels that the patient is very [elderly], and so what are they going to do with the information if they find a recurrence,” Dr. Cooper suggested in an interview at the symposium.

There also was some geographic variation in adherence to the guidelines, with the West coast being less compliant than the East coast, he said.

The study was supported by the American Cancer Society. Dr. Cooper said he had no conflicts of interest to disclose.

Just 30% of patients had the requisite testing for CEA, and only 74% had a colonoscopy within 3 years. DR. COOPER