title: Trends in surveillance for resected colorectal cancer, 2001-2009.
abstract: BACKGROUND
  Little is known about recent trends in surveillance among the more than 1 million US colorectal cancer (CRC) survivors. Moreover, for stage I disease, which accounts for more than 30% of survivors, the guidelines are limited, and the use of surveillance has not been well studied. Guidelines were changed in 2005 to include recommendations for computed tomography (CT) surveillance in select patients, but the impact of these changes has not been explored.
  
  
  METHODS
  A retrospective analysis of patients who were identified in the Survival, Epidemiology, and End Results-Medicare database and underwent resection of stage I to III CRC between 2001 and 2009 was performed. The receipt of guideline-determined sufficient surveillance, including office visits, colonoscopy, carcinoembryonic antigen (CEA) testing, and CT imaging, in the 3 years after resection was evaluated.
  
  
  RESULTS
  The study included 23,990 colon cancer patients and 5665 rectal cancer patients. Rates of office visits and colonoscopy were high and stable over the study period. Rates of CEA surveillance increased over the study period but remained low, even for stage III disease. Rates of CT imaging increased gradually during the study period, but the 2005 guideline change had no effect. Stage II patients, including high-risk patients, received surveillance at significantly lower rates than stage III patients despite similar recommendations. Conversely, up to 30% of stage I patients received nonrecommended CEA testing and CT imaging.
  
  
  CONCLUSIONS
  There continues to be substantial underuse of surveillance for CRC survivors and particularly for stage II patients, who constitute almost 40% of survivors. The 2005 guideline change had a negligible impact on CT surveillance. Conversely, although guidelines are limited, many stage I patients are receiving intensive surveillance.
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.|Philadelphia VA Medical Center, Philadelphia, Pennsylvania.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: E Carter
authors.initials: EC
authors.lastname: Paulson
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.|Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Veenstra
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Anil
authors.initials: A
authors.lastname: Vachani
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Ciunci
authors.affiliation: Philadelphia VA Medical Center, Philadelphia, Pennsylvania.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.|Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
mesh_terms: D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D062665:Epidemiological Monitoring; D005260:Female; D019983:Guideline Adherence / Q000639:trends*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D017741:Survivors
keywords: colon cancer; epidemiology; guideline adherence; rectal cancer; surveillance