Surveillance following treatment for colorectal cancer in Australia. Has best practice been adopted by medical oncologists?

Background:  Intensive follow up after surgery for colorectal cancer is associated with a significant survival advantage and is endorsed by expert panels, but are physicians convinced of the benefit? Methods:  A questionnaire was mailed to all members of the Medical Oncology Group of Australia, assessing surveillance practices after completion of adjuvant treatments. Results:  Responses were obtained from 141 (55%) medical oncologists of which 121 were considered evaluable. Thirteen per cent ( n  = 16) routinely did not carry out follow‐up investigations. Of those carrying out surveillance, 47% ( n  = 51) nominated identifying potentially resectable metastatic disease as prime consideration. Many (44%) were motivated by patient reassurance and expectation. Carcinoembryonic antigen levels were commonly monitored 3 monthly in years 1 (77%, n  = 85) and 2 (57%, n  = 63) and 6 monthly thereafter (67%, n  = 74). Eighty per cent ( n  = 88) carried out computed tomography (CT) surveillance 1 year after surgery, 69% ( n  = 76) at year 2 and 55% ( n  = 60) at year 3. Twenty‐six per cent ( n  = 29) continued scanning annually up to 5 years. Inclusion of CT chest was routine for 33% ( n  = 36) and never carried out by 11% ( n  = 12). Conclusion:  A significant minority (13%) of oncologists carry out no follow‐up investigations, despite level I evidence of a survival advantage similar to standard adjuvant therapies. Further education and study of physician attitudes and reservations to routine surveillance are required.