title: Adherence to surveillance guidelines after curative resection for stage II/III colorectal cancer.
abstract: OBJECTIVE
  Our aims were to determine adherence to American Society of Clinical Oncology (ASCO) guidelines on colorectal cancer (CRC) surveillance and to evaluate differences in practice patterns and clinical outcomes between an academic institution (Princess Margaret Hospital [PMH]) and a community cancer hospital (Credit Valley Hospital [CVH]).
  
  
  METHODS
  Patients with stage II/III CRC who were diagnosed between January 1, 1999, and December 31, 2001, were identified, and their records were retrospectively reviewed.
  
  
  RESULTS
  A total of 244 and 97 patients were eligible at PMH and CVH, respectively. Surveillance patterns, including blood tests, imaging studies, and colonoscopies, were inconsistent with ASCO recommendations in a significant proportion of patients. Clinic visits occurred more frequently and imaging studies were more commonly ordered at PMH than at CVH (P < .001). In contrast, CVH performed a higher median number of blood count and liver function tests (P = .001) per patient than PMH. The rates of carcinoembryonic antigen monitoring and surveillance colonoscopies were not statistically different between centers (P = .67 and P = .43, respectively). There were a total of 70 CRC recurrences: 53 (75.7%) were detected by surveillance (44 at PMH and 9 at CVH) and 17 (24.3%) by patient symptoms (9 at PMH and 8 at CVH). For recurrences detected by surveillance, 38% were resectable, whereas only 18% of those detected by symptoms were resectable.
  
  
  CONCLUSIONS
  Colorectal cancer surveillance revealed noticeable departures from ASCO guidelines, with the academic institution using a more intensive surveillance strategy with imaging studies than the community cancer center. Surveillance was associated with a higher proportion of resectable tumor recurrences than was detection by patient symptoms.
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, Ontario, Canada.
authors.forename: Winson Y
authors.initials: WY
authors.lastname: Cheung
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Pond
authors.forename: Mark
authors.initials: M
authors.lastname: Rother
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.forename: Carol
authors.initials: C
authors.lastname: Swallow
authors.forename: James
authors.initials: J
authors.lastname: Brierley
authors.forename: Leonard
authors.initials: L
authors.lastname: Kaizer
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Myers
authors.forename: Leena
authors.initials: L
authors.lastname: Hajra
authors.forename: Lillian L
authors.initials: LL
authors.lastname: Siu
mesh_terms: D000046:Academic Medical Centers; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D003153:Community Health Services; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies