Abstract
Background: Postoperative colon surveillance has been recommended for patients with a diagnosis
of local/regional colorectal cancer. The extent to which these recommendations are
followed in practice is poorly characterized. Patterns of surveillance after surgery
for colorectal cancer were determined by using a large population-based database.
Methods: This is a retrospective cohort study with cancer registry data linked to Medicare
claims. Identified were 52,283 patients treated for local/regional colorectal cancer
between 1986 and 1996, and surveillance patterns through 1998 were determined. Surveillance
patterns were analyzed by using survival analysis and by computing the proportion
of surviving patients who underwent procedures during 4 time periods after treatment:
2 to 14 months, 15 to 50 months, 51 to 86 months and more than 87 months. Results: Median times to first through fifth surveillance events were 20, 14, 15, 15, and
15 months, respectively. For 17% of the cohort there was no surveillance event. Younger
patients were more likely to undergo surveillance. Surveillance patterns were not
affected by stage. The proportions of the cohort that underwent no surveillance during
the 4 respective time periods were 54%, 52%, 60%, and 69%. The percentages of patients
who underwent surveillance annually or more frequently in the latter 3 time periods,
respectively, were 19%, 10%, and 5%, or 11% overall, treating the data for the 3 events
as a whole. Over the period from 1986 to 1998, the proportion of patients who had
no surveillance procedures gradually decreased, whereas the proportion of those who
underwent procedures annually or more frequently remained relatively constant. Conclusions: During the period from 1986 to 1998 there was low utilization of postdiagnosis colon
surveillance in a substantial proportion of elderly patients with a diagnosis of local/regional
colorectal cancer. Over time there was a trend toward increasing receipt of any surveillance
procedures. The percentages of patients undergoing surveillance annually or more frequently
did not change between earlier and later periods. (Gastrointest Endosc 2001;54:563-71.)
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Article info
Publication history
Accepted:
July 24,
2001
Received:
April 17,
2001
Footnotes
☆Reprint requests: Kevin B. Knopf, MD, MPH, Health Services and Economics Branch, Applied Research Program, DCCPS/NCI, EPN 4009A, 6130 Executive Blvd MSC 7344, Bethesda, MD 20892-7344.
Identification
Copyright
© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
