Adherence to national guidelines for surveillance after curative resection of nonmetastatic colon and rectum cancer: a survey among Norwegian gastrointestinal surgeons

Søreide, Kjetil; Træland, J. H.; Stokkeland, Pål Johan; Glomsaker, Tom; Søreide, Jon Arne; Kørner, Hartwig

doi:10.1111/j.1463-1318.2011.02631.x

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…The study cohort represents consecutive patients with non‐metastatic colorectal cancer (stage I–III) who were <75 years of age at diagnosis and who entered into an in‐hospital, surgeon‐led systematic surveillance program per national standards at the time, and as previously described at the time . All included patients presented between 1996 and 1999 and underwent curative surgery for colorectal cancer at the Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway.…”

Section: Methodsmentioning

confidence: 99%

Elevated microsatellite alterations at selected tetranucleotides in early‐stage colorectal cancers with and without high‐frequency microsatellite instability: same, same but different?

et al. 2016

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Microsatellite instability (MSI) is associated with better prognosis in colorectal cancer (CRC). Elevated microsatellite alterations at selected tetranucleotides (EMAST) is a less‐understood form of MSI. Here, we aim to investigate the role of EMAST in CRC±MSI related to clinical and tumor‐specific characteristics. A consecutive, population‐based series of stage I–III colorectal cancers were investigated for MSI and EMAST using PCR primers for 10 microsatellite markers. Of 151 patients included, 33 (21.8%) had MSI and 35 (23.2%) were EMAST+, with an overlap of 77% for positivity, (odds ratio [OR] 61; P < 0.001), and 95% for both markers being negative. EMAST was more prevalent in colon versus rectum (86% vs. 14%, P = 0.004). EMAST+ cancers were significantly more frequent in proximal colon (77 vs. 23%, P = 0.004), had advanced t‐stage (T3–4 vs. T1–2 in 94% vs. 6%, respectively; P = 0.008), were larger (≥5 cm vs. <5 cm in 63% and 37%, respectively; P = 0.022) and had poorly differentiated tumor grade (71 vs. 29%, P < 0.01). Furthermore, EMAST+ tumors had a higher median number of harvested lymph nodes than EMAST− (11 vs. 9 nodes; P = 0.03). No significant association was found between EMAST status and age, gender, presence of distant metastases or metastatic lymph nodes, and overall survival. A nonsignificant difference toward worse survival in node‐negative colon cancers needs confirmation in larger cohorts. EMAST+ cancers overlap and share features with MSI+ in CRC. Overall, survival was not influenced by the presence of EMAST, but may be of importance in subgroups such as node‐negative disease of the colon.

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Section: Methodsmentioning

confidence: 99%

Elevated microsatellite alterations at selected tetranucleotides in early‐stage colorectal cancers with and without high‐frequency microsatellite instability: same, same but different?

et al. 2016

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“…Finally, there exists a considerable variance in follow-up strategies, internationally and at a national level. 35 This makes the comparison of outcomes between different follow-up strategies challenging. For other cancer conditions, more cost-effective ways of organising follow-up are extensively described and evaluated.…”

Section: Comparison With Existing Literature and Ongoing Trialsmentioning

confidence: 99%

Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial

Augestad

Norum

Dehof³

et al. 2013

BMJ Open

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ObjectiveTo assess whether colon cancer follow-up can be organised by general practitioners (GPs) without a decline in the patient's quality of life (QoL) and increase in cost or time to cancer diagnoses, compared to hospital follow-up.DesignRandomised controlled trial.SettingNorthern Norway Health Authority Trust, 4 trusts, 11 hospitals and 88 local communities.ParticipantsPatients surgically treated for colon cancer, hospital surgeons and community GPs.Intervention24-month follow-up according to national guidelines at the community GP office. To ensure a high follow-up guideline adherence, a decision support tool for patients and GPs were used.Main outcome measuresPrimary outcomes were QoL, measured by the global health scales of the European Organisation for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ C-30) and EuroQol-5D (EQ-5D). Secondary outcomes were cost-effectiveness and time to cancer diagnoses.Results110 patients were randomised to intervention (n=55) or control (n=55), and followed by 78 GPs (942 follow-up months) and 70 surgeons (942 follow-up months), respectively. Compared to baseline, there was a significant improvement in postoperative QoL (p=0.003), but no differences between groups were revealed (mean difference at 1, 3, 6, 9, 12, 15, 18, 21 and 24-month follow-up appointments): Global Health; Δ−2.23, p=0.20; EQ-5D index; Δ−0.10, p=0.48, EQ-5D VAS; Δ−1.1, p=0.44. There were no differences in time to recurrent cancer diagnosis (GP 35 days vs surgeon 45 days, p=0.46); 14 recurrences were detected (GP 6 vs surgeon 8) and 7 metastases surgeries performed (GP 3 vs surgeon 4). The follow-up programme initiated 1186 healthcare contacts (GP 678 vs surgeon 508), 1105 diagnostic tests (GP 592 vs surgeon 513) and 778 hospital travels (GP 250 vs surgeon 528). GP organised follow-up was associated with societal cost savings (£8233 vs £9889, p<0.001).ConclusionsGP-organised follow-up was associated with no decline in QoL, no increase in time to recurrent cancer diagnosis and cost savings.Trial registrationClinicalTrials.gov identifier NCT00572143.

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“…Obtaining formalized and “objective” results (although based on the patients “subjective” report) might help surgeons and physicians to better communicate with patients during their treatment, especially with regard to patients’ expectations. Knowing that numerous clinical variables of uncertain value are regularly followed after cancer surgery such as for colorectal cancer (Kørner et al, 2005; Søreide et al, 2012), it is troublesome to know that validated PROM/QoL instruments have been put to use only rarely in the clinical setting.…”

Section: Proms In Surgical Cancer Care and Researchmentioning

confidence: 99%

Using Patient-Reported Outcome Measures for Improved Decision-Making in Patients with Gastrointestinal Cancer – the Last Clinical Frontier in Surgical Oncology?

Søreide¹,

Søreide²

2013

Front. Oncol.

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The genomic era has introduced concepts of “personalized medicine” and “targeted therapy” in the field of oncology. Medicine has become increasingly complex with a plethora of potential dilemmas in diagnosis, treatment, and management. The focus on classical outcomes for clinical decision-making is now increasingly being replaced by patient-reported outcome measures (PROMs). PROMs should increasingly now be in the center of patient-centered decision-making, based on valid, reliable, and clinically useful measures delivered directly by the patient to the caregiver. Surgeons’ ability to interpret and apply PROMs and quality of life results must improve by education and further research, and has an unreleased potential to contribute to a better understanding of the patients’ well-being. A number of caveats must be addressed before this can be brought to fruition; standardization for valid items; appropriate use of instruments; correct timing of the application; missing data handling, compliance, and respondent drop-outs are but a few issues to be addressed. Based on the apparent lack of use in both research and clinical work, it should call for an educational effort to address this among surgeons caring for patients with cancer.

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Adherence to national guidelines for surveillance after curative resection of nonmetastatic colon and rectum cancer: a survey among Norwegian gastrointestinal surgeons

Abstract: All hospitals reported having a strategy for surveillance after surgery for colon and rectal cancer, but there was considerable variance in strategy. A scientific audit of the true level of compliance, effectiveness and cost-benefit is warranted at a national level.

Cited by 17 publications

References 22 publications

Elevated microsatellite alterations at selected tetranucleotides in early‐stage colorectal cancers with and without high‐frequency microsatellite instability: same, same but different?

Elevated microsatellite alterations at selected tetranucleotides in early‐stage colorectal cancers with and without high‐frequency microsatellite instability: same, same but different?

Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial

Using Patient-Reported Outcome Measures for Improved Decision-Making in Patients with Gastrointestinal Cancer – the Last Clinical Frontier in Surgical Oncology?

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