Inadequate quality of surveillance after curative surgery for colon cancer.
BACKGROUND
Colon cancer patients are at risk for recurrence. Recurrent disease might be curable if detected early by surveillance. However, data on the quality of surveillance are scarce. The objective of this study is to analyze the quality of surveillance after curative surgery for colon cancer among a cohort of Swiss patients.


METHODS
After curative surgery, 129 stage I-III colon cancer patients were followed by chart review, questionnaires, and phone interviews. National surveillance guidelines mandate periodic measurement of carcinoembryonic antigen (CEA) levels, abdominal ultrasound or computed tomography (US/CT), and colonoscopy. However, surveillance was left to the discretion of the treating physicians. Actual surveillance was compared with the recommendations in the guidelines.


RESULTS
Datasets of all 129 patients were available. Median follow-up was 33.5 months (range 5.6-74.7 months). Eighteen patients (14.0%) recurred during follow-up. Three-year overall and disease-free survival were 94.7% and 83.5%, respectively. Periodic CEA measurements, US/CT, and colonoscopies as recommended by the guidelines were performed in 32.8%, 31.7%, and 23.8% of patients, respectively. Forty-four patients (34.1%) received adjuvant chemotherapy. For these patients there was a trend towards better compliance with national surveillance guidelines than for patients without adjuvant chemotherapy.


CONCLUSIONS
The quality of surveillance after curative surgery for colon cancer among a cohort of Swiss patients is inadequate. Further education of health care professionals and patients regarding the potential life-saving benefits of surveillance is imperative. It is cardinal that quality of surveillance is critically analyzed in other countries with different health care systems as well.
Viehl
Carsten T
CT
Department of Surgery, University Hospital Basel, Basel, Switzerland.
Ochsner
Alex
A
von Holzen
Urs
U
Cecini
Ramona
R
Langer
Igor
I
Guller
Ulrich
U
Laffer
Urban
U
Oertli
Daniel
D
Zuber
Markus
M
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002272:Carcinoembryonic Antigen / Q000032:analysis; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011159:Population Surveillance; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors
D002272:Carcinoembryonic Antigen