ORLANDO — Most colorectal cancer patients who undergo potentially curative resection of their tumors after age 65 do not receive the follow-up care recommended by clinical practice guidelines, the results of a large population-based study suggest.
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 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. He and his colleagues analyzed 9,246 patients older than 65 years with local or regional colorectal cancer that was diagnosed in 2000 and 2001 and resected with curative intent. The mean age of the patients was 77 years; 55% were female, 87% were white.
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.
Dr. Cooper 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. The study was supported by the American Cancer Society. Dr. Cooper had no conflicts of interest to disclose.