Community compliance with carcinoembryonic antigen: follow-up of patients with colorectal cancer.
OBJECTIVE
The aim of this study was to determine whether recommendations for surveillance carcinoembryonic antigen (CEA) testing in stage II/III colorectal cancer (CRC) are adhered to upon discharge from our cancer center, patterns of care after CEA elevation, and whether differences in outcomes exist between patients who did and did not receive recommended CEA monitoring.


METHODS
A retrospective, single-institution chart review was completed at the Cross Cancer Institute (CCI) in Edmonton, Alberta. The Alberta Cancer Registry (ACR) identified patients with CRC diagnosed between January 1 and December 31, 2001. Patients with stage II/III CRC seen and/or treated at the CCI and later discharged to the community with follow-up recommendations based on American Society of Clinical Oncology guidelines were included. Carcinoembryonic antigen monitoring > or = every 4 months for > or = 2 years was deemed acceptable for study purposes.


RESULTS
The ACR identified 152 stage II/III CRC cases meeting inclusion criteria. Eleven patients (7.2%) received the minimum predefined CEA follow-up. Eighty-seven CEA follow-up tests were elevated; only 20 (23%) elevated CEAs were investigated with predefined timely intervention. Twenty-six patients (17.1%) had documentable tumor recurrence. There was no difference in overall survival or time to recurrence between the groups who received and did not receive appropriate follow-up, although small numbers limit the effectiveness of statistical analysis.


CONCLUSIONS
Post-therapy surveillance is important in CRC management. Our study reveals follow-up recommendations based on best available evidence for interval CEA testing are not followed in the community. These findings suggest the need for review of recommendations and change in management for monitoring discharged patients with stage II/III CRC.
Spratlin
Jennifer L
JL
Faculty of Medicine and Dentistry, Department of Medicine, Division of Medical Oncology, University of Alberta, Canada.
Hui
David
D
Hanson
John
J
Butts
Charles
C
Au
Heather-Jane
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D014408:Biomarkers, Tumor / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D015179:Colorectal Neoplasms / Q000276:immunology* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D010349:Patient Compliance; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012017:Referral and Consultation; D012042:Registries; D012111:Residence Characteristics; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen