title: Large variation between hospitals in follow-up for colorectal cancer in southern Netherlands.
abstract: OBJECTIVE
  The aims of the study were to describe the follow-up of colorectal cancer (CRC) patients in southern Netherlands and examine their overall and disease-free survival.
  
  
  METHODS
  Patients newly diagnosed with CRC in 2003-2005 and 2008 with a survival of at least 1 year after diagnosis and recorded in the retrospective Eindhoven Cancer Registry were included (n = 579). Follow-up was defined as at least one liver imaging and at least two carcinoembryonic antigen (CEA) measurements. Logistic regression analyses were conducted to assess determinants of follow-up. Proportions of patients undergoing colonoscopy, CEA measurements and liver and chest imaging were calculated. Overall and disease-free survival were calculated.
  
  
  RESULTS
  Patients ≥75 years (odds ratio (OR) 0.5 (95% confidence interval (CI) 0.3-0.7)) were less likely to receive follow-up, contrasting patients <50 years (OR 3.1 (95% CI 1.3-7.4)). In 2008, follow-up intensity increased (OR 2.3 (95% CI 1.2-4.3)), especially for liver imaging and CEA measurements. There were large differences in follow-up intensity and activities between hospitals, which were unaffected by comorbidity: ranges for colonoscopy 15-73 %, CEA measurement 46-91 % and imaging of the liver 22-70 % between hospitals. No effect of follow-up intensity was found on 5-year disease-free survival for patients aged <75 years (64 vs. 68 %; p = 0.6). Similarly, no effect of follow-up intensity on 5-year overall survival was found in these patients (77 vs. 82 %; p = 0.07).
  
  
  CONCLUSIONS
  Large variation in follow-up was found for patients with CRC, mainly declining with age and hospital of follow-up. Over time, follow-up became more intensive, especially with respect to liver imaging and CEA measurements. However, follow-up consisting of at least one liver imaging and at least two CEA measurements did not improve overall and disease-free survival.
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, PO Box 231, 5600 AE Eindhoven, the Netherlands. research@ikz.nl
authors.forename: L N
authors.initials: LN
authors.lastname: van Steenbergen
authors.forename: I H J T
authors.initials: IH
authors.lastname: de Hingh
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.forename: M C M
authors.initials: MC
authors.lastname: Rijk
authors.forename: R G
authors.initials: RG
authors.lastname: Orsini
authors.forename: J W W
authors.initials: JW
authors.lastname: Coebergh
authors.forename: V E P P
authors.initials: VE
authors.lastname: Lemmens
mesh_terms: D000368:Aged; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen