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Receipt of guideline‐recommended follow‐up in older colorectal cancer survivors
Author(s) -
Cooper Gregory S.,
Kou Tzuyung Doug,
Reynolds Harry L.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23823
Subject(s) - medicine , guideline , colorectal cancer , receipt , cancer , gerontology , oncology , family medicine , pathology , world wide web , computer science
BACKGROUND After curative resection for colorectal cancer, routine follow‐up with office visits, carcinoembryonic antigen (CEA), and colonoscopy is recommended. The actual adherence to these guidelines as well as the potential overuse of testing in routine practice has not been well studied. METHODS The authors identified 9426 eligible patients aged ≥66 years in a linked tumor registry‐claims database who were diagnosed with adenocarcinoma of the colon or rectum from 2000 to 2001. Patients were observed to 3 years after diagnosis. Receipt of ≥2 office visits per year, ≥2 CEA tests per year (years 1 and 2), and ≥1 colonoscopy within 3 years constituted guideline fulfillment. RESULTS Guidelines for office visits, colonoscopy, and CEA testing were met in 92.3%, 73.6%, and 46.7% of patients, respectively. In addition, receipt of 2 nonrecommended procedures, abdominal/pelvic computed tomography scans and positron emission tomography scans, was documented in 47.7% and 6.8%, respectively. Overall, 60.2% received testing below recommended levels, 17.1% at recommended frequency, and 22.7% above guideline recommendations. In a multivariate analysis, factors associated with meeting guidelines included younger age group, white race, regional stage cancers, and poorly differentiated tumors. Considerable geographic variation in meeting guidelines was also observed. CONCLUSIONS Many older colorectal cancer survivors in this population‐based cohort underwent testing below a minimum frequency specified by clinical practice guidelines, especially with regard to CEA. Further studies should ascertain the reasons for poor compliance and the effect on patient outcome. Cancer 2008. © 2008 American Cancer Society.