Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and meta-analysis

Pita-Fernández, Salvador; Alhayek-Aí, Mohammed; González-Martín, Cristina; López‐Calviño, Beatriz; Seoane-Pillado, Teresa; Pértega-Díaz, Sonia

doi:10.1093/annonc/mdu543

Cited by 222 publications

(187 citation statements)

References 38 publications

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“…16 Two meta-analyses have also supported the use of 1-year follow-up colonoscopies. 4,29 Despite the fact that most guidelines recommend 1-year follow-up surveillance colonoscopy, we found that nonadherence was substantial. Four other studies conducted in large population-based administrative databases found comparable results.…”

Section: Discussionmentioning

confidence: 67%

“…The rationales for these recommendations stem from observational studies and clinical trials that have shown improved progression-free and overall survival rates for those found to have liver or lung metastases who have undergone metastasectomies. 4,5 The guidelines [1][2][3]6 also recommend a surveillance colonoscopy at 1 year following surgery. This has two goals: to remove metachronous lesions which may arise rapidly after the initial resection or which may represent missed lesions; [7][8][9][10][11] and to identify anastomotic recurrences which may develop in up to 4% of patients.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to colonoscopy at 1 year following resection of localized colon cancer: a retrospective cohort study

Neugut

Zhong

Lebwohl

et al. 2018

Therap Adv Gastroenterol

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Background: For patients with stages I-III colon cancer who have undergone surgical resection, guidelines recommend surveillance colonoscopy at 1 year. However, limited data exist on adherence and associated factors. We aimed to determine the rate of adherence to surveillance colonoscopy at 1 year among nonmetastatic colon cancer patients who underwent resection and factors associated with adherence. Methods: In this population-based retrospective cohort study, the Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used. We identified patients with stages I-III colon cancer who underwent surgical resection and survived >3 years without recurrence (no chemotherapy after 8 months) from 2002-2011. Our primary outcome was a colonoscopy claim 10-15 months after resection. We used multivariable regression analysis to assess associations between sociodemographic and clinical factors and receipt of timely colonoscopy. Results: Among 28,732 patients who survived >3 years without recurrence, 7967 (28%) did not undergo colonoscopy; 12,033 (42%) had it at one year, with 3159 (11%) before 10 months and 5573 (19%) after 15 months. Decreased adherence was associated with older age; being male versus female; being black or Hispanic versus white; higher tumor stage; left-sided tumors versus right sided; and increased comorbidities. Chemotherapy receipt was associated with increased adherence (odds ratio 2.06; 95% confidence interval 1.88-2.24). Conclusions:In a large population-based sample of individuals aged ⩾ 65 years, only 42% of colon cancer survivors underwent 1-year surveillance colonoscopy. Demographic and clinical factors were associated with adherence.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Adherence to colonoscopy at 1 year following resection of localized colon cancer: a retrospective cohort study

Neugut

Zhong

Lebwohl

et al. 2018

Therap Adv Gastroenterol

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“…A recent systematic review concluded that intensive follow-up strategies were associated neither with improved cancer-specific survival, nor with a higher detection rate for tumour recurrences after curative treatment of CRC [9]. The FACS-trial, the most recent randomized controlled trial comparing multiple follow-up strategies with the same intensity but different components, suggested that follow-up should include at least one of the 2 components, CEA or imaging [3].…”

Section: Introductionmentioning

confidence: 99%

Nonphysician Clinicians in the Follow-Up of Resected Patients with Colorectal Cancer

Braak¹,

Lalmahomed²,

Büttner³

et al. 2017

Dig Dis

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Background/Aims: The 5-year postoperative follow-up for patients undergoing curative treatment for colorectal cancer (CRC) is labour intensive. We assessed the added value of a dedicated nonphysician clinician (NPC) in the follow-up of patients after resection for CRC. Methods: Patients were divided into 2 groups as defined by the number of follow-up visits in the first year, including intensive (≥3×) and minimal (≤2×). Involvement of an NPC, diagnosis of disease recurrence and the course of the disease were determined. Results: Of the 681 patients, 79.9% belonged to the “intensive” and 21.1% to the “minimal” group. Involvement of an NPC resulted in a higher adherence to follow-up (84.3 vs. 73.9%, p = 0.001). Overall, patients in regular follow-up less often had multifocal recurrence (47.1 vs. 73.7%, p = 0.04), and a better survival after recurrence (SAR; hazard ratio [HR] 3.604, p < 0.001). The “intensive” group had a significantly better overall survival compared to the “minimal” group (HR 1.71, p = 0.013). Conclusion: Adherence to surveillance programs after resection for CRC is better in hospitals with a dedicated NPC. Overall, patients' adherence to follow-up resulted in less multifocal disease recurrence at the time of diagnosis as compared to patients presenting with symptoms and a better 3-year SAR.

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“…That study showed no difference in time to detection of recurrence, OS, or quality of life assessments at any interval between the stage-matched cohorts [23]. Multiple randomized trials and separate meta-analyses support a modest but significant OS benefit for intensive posttreatment surveillance following potentially curative resection of colorectal cancer [24-27]. However, the best surveillance strategy to achieve such a benefit has not been defined because the strategies within trials varied significantly.…”

Section: Discussionmentioning

confidence: 99%

Actionable Locoregional Relapses after Therapy of Localized Esophageal Cancer: Insights from a Large Cohort

et al. 2018

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Objective: The goal of surveillance after therapy of localized esophageal cancer (LEC) is to identify actionable relapses amenable to salvage; however, the current surveillance algorithms are not optimized. We report on a large cohort of LEC patients with actionable locoregional relapses (LRRs). Methods: Between 2000 and 2013, 127 (denominator = 752) patients with actionable LRR were identified. Histologic/cytologic confirmation was the gold standard. All surveillance tools (imaging, endoscopy, fine needle aspiration) were assessed. Results: Most patients were men (89%), had adenocarcinoma (79%), and had no new symptoms (72%) when diagnosed with LRR. In trimodality patients, endoscopic confirmation of positron emission tomography-computed tomography-suspected LRR occurred in only 44%, and 56% required additional tools (e.g., fine needle aspiration). Alternatively, in bimodality patients, endoscopy confirmed LRRs in 81%. Trimodality patients had a higher risk of subsequent LRR/distant metastases after the first LRR than the bimodality patients (p = 0.03). In all patients, 78% of the subsequent relapses were distant. For patients who were salvaged, survival was significantly prolonged (50.6 vs. 25.1 months, p < 0.01). Conclusions: Patients live longer after successful salvage of the LRR than if salvage is not possible. After LRR, patients have a high risk of subsequent distant metastasis and whether the second relapse is local or distant, survival is uniformly poor.

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Intensive follow-up strategies improve outcomes in nonmetastatic colorectal cancer patients after curative surgery: a systematic review and meta-analysis

Cited by 222 publications

References 38 publications

Adherence to colonoscopy at 1 year following resection of localized colon cancer: a retrospective cohort study

Adherence to colonoscopy at 1 year following resection of localized colon cancer: a retrospective cohort study

Nonphysician Clinicians in the Follow-Up of Resected Patients with Colorectal Cancer

Actionable Locoregional Relapses after Therapy of Localized Esophageal Cancer: Insights from a Large Cohort

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