Major differences in follow-up practice of patients with colorectal cancer; results of a national survey in the Netherlands

Abstract

Background: The precise content and frequency of follow-up of patients with colorectal cancer (CRC) is variable and guideline adherence is low. The aim of this study was to assess the view of colorectal surgeons on their local follow-up schedule and to clarify their opinions about risk-stratification and organ preserving therapies. Equally important, adherence to the Dutch national guidelines was determined. Methods: Colorectal surgeons were invited to complete a web-based survey about the importance and interval of clinical follow-up, CEA monitoring and the use of imaging modalities. Furthermore, the opinions regarding physical examination, risk-stratification, organ preserving strategies, and follow-up setting were assessed. Data were analyzed using quantitative and qualitative analysis methods. Results: A total of 106 colorectal surgeons from 52 general and 5 university hospitals filled in the survey, yielding a hospital response rate of 74% and a surgeon response rate of 42%. The follow-up of patients with CRC was mainly done by surgeons (71%). The majority of the respondents (68%) did not routinely perform physical examination during follow-up of rectal patients. Abdominal ultrasound was the predominant modality used for detection of liver metastases (77%). Chest X-ray was the main modality for detecting lung metastases (69%). During the first year of follow-up, adherence to the minimal guideline recommendations was high (99-100%). The results demonstrate that, within the framework of the guidelines, some respondents applied a more intensive follow-up and others a less intensive schedule. The majority of the respondents (77%) applied one single follow-up imaging schedule for all patients that underwent treatment with curative intent. Conclusions: Dutch colorectal surgeons' adherence to minimal guideline recommendations was high, but within the guideline framework, opinions differed about the required intensity and content of clinical visits, the interval of CEA monitoring, and the importance and frequency of imaging techniques. This national survey demonstrates current follow-up practice throughout the Netherlands and highlights the follow-up differences of curatively treated patients with CRC.

Health care provider and patient preparedness for alternative colorectal cancer follow-up; a review

“…Besides content and frequency of follow-up, the surveillance setting (e.g. hospital-based, primary are-based or otherwise) is also highly variable [15,16]. Providing suitable follow-up for the growing number of CRC survivors can put pressure on outpatient services and compromise the ability to see new referrals or reassess patients [17].…”

Surgical rather than endoscopic resection of early-stage colorectal cancers promotes excessive imaging surveillance

“…The corresponding values for intensive surveillance were 40.7% and 8.2%, respectively. Whereas major differences in follow-up practices for patients with CRC have been previously reported for more advanced tumours [18], there are no reported data for early-stage cancers. Multivariable analysis of the entire cohort identified 3 factors associated with imaging surveillance in this study, i.e., the cancer stage, the gastroenterologist in charge of the initial diagnosis and management and surgical vs endoscopic resection of the malignant polyp.…”

Pathological and clinical features of multiple cancers and lung adenocarcinoma: a multicentre study

“…Chest imaging is not always recommended. Moreover, adherence to guidelines might be limited by institutional protocols or personal beliefs [ 31 , 32 ]. Recent studies stressed that chest CT imaging does not add any benefit in patients affected by early-stage breast cancer [ 33 ] and after hepatocellular carcinoma [ 34 ], whereas it might be worthwhile in selected patients who have melanoma [ 35 ]; on the other hand, a chest CT scan is suggested for patients operated on for lung cancer.…”