“The current study is the first known national, population-based study in the US to examine actual adherence to published comprehensive guidelines. The study included patients cared for in diverse practice settings and by different specialists,” lead author Dr. Gregory S. Cooper told Reuters Health.
“The biggest finding was the low rate of guideline adherence, with approximately 60% receiving less than recommended care and, in contrast, 20% received care in excess of guidelines,” according to Dr. Cooper, a gastroenterologist with University Hospitals Case Medical Center in Cleveland, Ohio. “All patients were insured under Medicare, so lack of insurance cannot be a factor.”
Using a linked tumor registry-claims database, the researchers identified 9426 patients, 66 years of age and older, who were observed for 3 years following diagnosis and treatment of colorectal cancer in 2000 to 2001. The subjects were classified as receiving recommended follow-up if they had at least two office visits per year, at least two CEA tests per year in years 1 and 2, and if they had at least one colonoscopy performed within 3 years.
Overall, 60.2% of patients received follow-up below recommended levels and 22.7% received excessive follow-up, according to the report in the October 15th issue of Cancer. Thus, just 17.1% of patients received follow-up at the recommended frequency.
Guideline adherence ranged from 92.3% for office visits to 46.7% for CEA testing, while 73.6% of patients underwent recommended colonoscopy.
Although not recommended, abdominal/pelvic CT was performed in 47.7% of patients and PET scan was performed in 6.8%.
Independent predictors of guideline adherence included younger age, white race, regional stage malignancies, and poor differentiated tumors, the report indicates. The findings also indicate significant variation in guideline adherence by geographic location. This suggests that local practice patterns play a role in receipt of recommended follow-up, Dr. Cooper noted.
“The take-home message is that routine surveillance has been shown to improve survival after potentially curative treatment of colorectal cancer,” Dr. Cooper said. “Assuming that the patient would benefit from early detection of recurrence, the use of these procedures should be encouraged. As some of these patients may be receiving their care from primary care physicians alone, primary providers should also be aware of guidelines.”