Surveillance following treatment for colorectal cancer in Australia. Has best practice been adopted by medical oncologists?
BACKGROUND
Intensive follow up after surgery for colorectal cancer is associated with a significant survival advantage and is endorsed by expert panels, but are physicians convinced of the benefit?


METHODS
A questionnaire was mailed to all members of the Medical Oncology Group of Australia, assessing surveillance practices after completion of adjuvant treatments.


RESULTS
Responses were obtained from 141 (55%) medical oncologists of which 121 were considered evaluable. Thirteen per cent (n = 16) routinely did not carry out follow-up investigations. Of those carrying out surveillance, 47% (n = 51) nominated identifying potentially resectable metastatic disease as prime consideration. Many (44%) were motivated by patient reassurance and expectation. Carcinoembryonic antigen levels were commonly monitored 3 monthly in years 1 (77%, n = 85) and 2 (57%, n = 63) and 6 monthly thereafter (67%, n = 74). Eighty per cent (n = 88) carried out computed tomography (CT) surveillance 1 year after surgery, 69% (n = 76) at year 2 and 55% (n = 60) at year 3. Twenty-six per cent (n = 29) continued scanning annually up to 5 years. Inclusion of CT chest was routine for 33% (n = 36) and never carried out by 11% (n = 12).


CONCLUSIONS
A significant minority (13%) of oncologists carry out no follow-up investigations, despite level I evidence of a survival advantage similar to standard adjuvant therapies. Further education and study of physician attitudes and reservations to routine surveillance are required.
Kosmider
S
S
Department of Medical Oncology, Royal Melbourne Hospital, University of Melbourne, Royal Parade, Parkville, Vic. 3052, Australia.
Field
K
K
Jefford
M
M
Jennens
R
R
Gibbs
P
P
D001315:Australia / Q000453:epidemiology; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D008495:Medical Oncology / Q000379:methods*; D009017:Morbidity; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen