Detection of recurrence after surgery for colorectal cancer.
Of all patients operated for colorectal cancer, 1 in 3 will suffer from cancer recurrence, and most of these patients will die from disseminated disease. Postoperative follow-up aims at improving these grim figures. This sound idea has not been supported by any empirical data. In the current article, we discuss some theoretical issues concerning colorectal cancer follow-up, and present results of a cost-effectiveness analysis, used to model the natural history of colorectal cancer recurrence and the costs and effects of follow-up and re-operation. The expected results of three policies were calculated: no follow-up, selective follow-up and intensive follow-up. For most patients, follow-up will only lead to a significant increase in costs, without increase in (quality-adjusted) life expectancy. Colorectal cancer follow-up is not "evidence-based medicine".
Kievit
J
J
Dept of Surgery, Leiden University Hospital, The Netherlands.
Bruinvels
D J
DJ
D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D019057:Quality-Adjusted Life Years