title: Impact of a dedicated cancer center surveillance program on guideline adherence for patients with stage II and III colorectal cancer.
abstract: Surveillance after curative treatment for stage II/III colorectal cancer identifies surgically resectable disease and improves survival. We evaluated adherence to guidelines and outcomes for 408 patients enrolled in an innovative follow-up program at our cancer center. We found that a dedicated intensive surveillance program can impact adherence to guidelines for patients with colorectal cancer.
  
  
  BACKGROUND
  Our aims were to evaluate adherence to guidelines on colorectal cancer surveillance and outcomes for patients enrolled in an innovative follow-up program at our cancer center.
  
  
  METHODS
  A retrospective chart review was conducted at the Cross Cancer Institute in Edmonton, Canada. Patients with stage II/III colorectal cancer who completed treatment and who entered into the program from December 1, 2007, to December 31, 2009, were identified. The minimum standard of care follow-up was defined as (1) carcinoembryonic antigen (CEA) testing every 120 days for 3 years; (2) computed tomography of chest, abdomen, and pelvis at 10 to 14 months and 22 to 26 months after surgery; and (3) colonoscopy within 14 months of surgery.
  
  
  RESULTS
  A total of 408 patients met inclusion criteria. Two hundred (49.0%) patients were adherent to all 3 components of surveillance. Among all patients, 57 (14.0%) were nonadherent to computed tomography imaging, 135 (33.1%) were nonadherent to colonoscopy, and 96 (23.5%) were nonadherent to CEA testing. Determinants of nonadherence are described. In total, 192 (47.2%) patients had an abnormal surveillance investigation that led to 307 follow-up events. After a median of 1.6 years, 69 (16.9%) patients had documented tumor recurrence. Sixty-one (88.4%) of these 69 patients had recurrence diagnosed via surveillance, and 31 (44.9%) patients were considered potentially resectable.
  
  
  CONCLUSIONS
  Our study demonstrated an improvement in CEA testing since the program began; however, adherence rates for all components are not yet optimal. Alterations to surveillance program management are outlined. Further investigation will determine whether intense follow-up improves patient survival locally.
authors.affiliation: Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Leah
authors.initials: L
authors.lastname: Standeven
authors.forename: Julie
authors.initials: J
authors.lastname: Price Hiller
authors.forename: Karen
authors.initials: K
authors.lastname: Mulder
authors.forename: George
authors.initials: G
authors.lastname: Zhu
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Spratlin
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities / Q000458:organization & administration; D002272:Carcinoembryonic Antigen / Q000097:blood; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen