Evaluating adherence to post-treatment follow-up of colorectal cancer at a reference center in Mexico: A retrospective analysis.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 51-51
Author(s):  
Jorge Humberto Hernandez-Felix ◽  
Mónica Isabel Meneses Medina ◽  
Mauricio Rivera Aguilar ◽  
Ana Karen Valenzuela ◽  
Vanessa Rosas Rosas Camargo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Post Treatment ◽  
Cancer Surveillance ◽  
Stage I ◽  
Bivariate Analysis ◽  
Surveillance Period ◽  
Physician Visits ◽  
Reference Center ◽  
Nccn Guidelines

51 Background: Adequate post-treatment surveillance for colorectal cancer (CRC) is recommended by all major societies with the intention to improve overall survival. However, compliance is variable and has not been studied in our country. Our aim was to evaluate the adherence to post-treatment surveillance NCCN guidelines for CRC at our Institution in Mexico City. Methods: We retrospectively reviewed charts from patients with stage I-III CRC who were diagnosed between January 2014 and December 2016. Adherence to surveillance was evaluated for the first 3 years after completion of oncologic treatment or until recurrence, whichever came first. We used an adherence composite definition previously defined by Cooper et al, where adequate compliance with guidelines was considered if patients had ≥2 physician visits per year for 3 years, ≥2 CEA tests per year for 2 years, and at least one colonoscopy in the 3-years surveillance period. Results: We included 90 patients. Mean age at diagnosis was 62 ± 12.5 years, 53% (n=48) were male, 68% (n=62) had colon cancer and 31% (n=28) rectal cancer. According to AJCC7 19% (n=17) were Stage I, 39% (n=35) II, and 42%(n=38) III. Median score for Charslon index at diagnosis was 4 (IQR 3-6). Results of follow-up adherence are presented in Table. Just 12% (n=11) of patients had a PET/CT or any other non-indicated imaging study for surveillance. Recurrence rate at the 3rd year of surveillance was 6.6% (n=6). A bivariate analysis was performed to find clinical and demographic factors associated to adherence and individual components of surveillance, we did not find any significative association. Conclusions: At our institution compliance with follow-up guidelines for CRC is good and higher than reported by other centers, though individual components have a decreasing trend in adherence every year. This could be explained because in our Institution cancer surveillance is performed by a medical oncologist. The main limitation of our study is that it involves an individual reference center in Mexico; thus, extrapolating data may not be feasible. [Table: see text]

scholarly journals Colorectal Cancer Surveillance after Index Colonoscopy: Guidance from the Canadian Association of Gastroenterology

2013 ◽  
Vol 27 (4) ◽  
pp. 224-228 ◽  
Author(s):  
Desmond Leddin ◽  
Robert Enns ◽  
Robert Hilsden ◽  
Carlo A Fallone ◽  
Linda Rabeneck ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Task Force ◽  
Cancer Surveillance ◽  
Screening Tests ◽  
Average Risk ◽  
Health Care Environment ◽  
Canadian Association ◽  
The Us ◽  
Colonoscopy Surveillance

BACKGROUND: Differences between American (United States [US]) and European guidelines for colonoscopy surveillance may create confusion for the practicing clinician. Under- or overutilization of surveillance colonoscopy can impact patient care.METHODS: The Canadian Association of Gastroenterology (CAG) convened a working group (CAG-WG) to review available guidelines and provide unified guidance to Canadian clinicians regarding appropriate follow-up for colorectal cancer (CRC) surveillance after index colonoscopy. A literature search was conducted for relevant data that postdated the published guidelines.RESULTS: The CAG-WG chose the 2012 US Multi-Society Task Force (MSTF) on Colorectal Cancer to serve as the basis for the Canadian position, primarily because the US approach was the simplest and comprehensively addressed the issue of serrated polyps. Aspects of other guidelines were incorporated where relevant. The CAG-WG recommendations differed from the US MSTF guidelines in three main areas: patients with negative index colonoscopy should be followed-up at 10 years using any of the appropriate screening tests, including colonos-copy, for average-risk individuals; among patients with >10 adenomas, a one-year interval for subsequent colonoscopy is recommended; and for long-term follow-up, patients with low-risk adenomas on both the index and first follow-up procedures can undergo second follow-up colonos-copy at an interval of five to 10 years.DISCUSSION: The CAG-WG adapted the US MSTF guidelines for colonoscopy surveillance to the Canadian health care environment with a few modifications. It is anticipated that the present article will provide unified guidance that will enhance physician acceptance and encourage appropriate utilization of recommended surveillance intervals.

Surveillance with Serial Serum Carcinoembryonic Levels Detect Colorectal Cancer Recurrences in Patients who are Initial Nonsecretors

2010 ◽  
Vol 76 (10) ◽  
pp. 1100-1103 ◽  
Author(s):  
Alicia Holt ◽  
Rebecca A. Nelson ◽  
Lily Lai
Keyword(s):  
Colorectal Cancer ◽  
Carcinoembryonic Antigen ◽  
Retrospective Review ◽  
Stage I ◽  
Recurrent Colorectal Cancer ◽  
Serum Carcinoembryonic Antigen ◽  
Serial Serum ◽  
Resected Stage ◽  
Initial Resection

Serum carcinoembryonic antigen (CEA) levels, elevated in a subgroup of patients with colorectal cancer (CRC) at presentation, are serially followed as part of recommended surveillance after initial resection. The value of following serial CEA levels in patients who initially present with less than or normal levels of CEA (nonsecretors) is controversial. This study sought to determine the use of follow-up CEA levels in nonsecretors. A retrospective review was performed of patients with resected Stage I, II, and III CRC. We excluded patients who did not have a pretreatment CEA level, at least two follow-up CEA levels, or in whom CEA levels did not normalize after resection. The patients were grouped by initial CEA values: CEA 5 ng/mL or less (nonsecretors) and CEA 5 + ng/mL: (secretors). We identified 186 patients with CRC; 146 were initial nonsecretors. We identified 22 patients with recurrent colorectal cancer; 6 were secretors and 16 patients were nonsecretors. In the secretors group, CEA was elevated with recurrence in four (66%) of the patients. In the nonsecretors, CEA was elevated with recurrence in eight (50%) of the patients. In summary, many recurrences of CRC are marked by an elevation of CEA regardless of whether the patients initially presented as secretors or nonsecretors.

scholarly journals Optimal Follow-up of Stage I Colorectal Cancer Patients

2006 ◽  
Vol 59 (10) ◽  
pp. 857-862 ◽  
Author(s):  
T. Higuchi ◽  
M. Enomoto ◽  
K. Sugihara
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Stage I ◽  
Colorectal Cancer Patients

QIM19-124: Does Virtual Navigation Improve Care Continuity and Compliance in Patients With Early Stage Colon Cancer?

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-124
Author(s):  
Dayna Crawford ◽  
Brook Blackmore ◽  
Jeremy Ortega ◽  
Erica Williams
Keyword(s):  
Colon Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Stage I ◽  
Stage Iii ◽  
Nccn Guidelines ◽  
Care Continuity ◽  
Colon Cancers ◽  
Follow Up Care

Background: Colon cancer is the 3rd most common cancer in men and women combined, with an occurrence rate of 4.49% for men and 4.15% for women. The 2018 expectation is 50,630 deaths related to colon cancer in the United States (American Cancer Society Facts and Figures 2018). Early detection is increasing with nearly 45% of colon cancers diagnosed as stage I/II (Sarah Cannon Cancer Registry 2015). Treatment for early stage I/II colon cancer patients usually involves surgery then surveillance. On-site navigators perform their duties by patient need and barriers to care. Late stage III/IV colon cancer patients require more assistance and face more barriers, which often leaves early stage I/II patients without an advocate. This disparity can lead to lower rates of follow-up care for early stage I/II patients. Sarah Cannon created a program for virtual colon navigation (VCN) to determine if early stage I/II patients benefit from a virtual navigator who offers support by phone throughout their disease process. Objectives: The goal was to increase early stage I/II patients’ knowledge of their cancer and convey the importance of compliance with follow-up care, such as repeat colonoscopy as recommended by their physician and NCCN Guidelines. Methods: By developing software that utilizes artificial intelligence, Sarah Cannon created an automated process to identify colon cancer patients at the time of diagnosis. This technology then routes positive pathology reports to a VCN who contacts the early stage I/II patients by telephone, ensuring patient connection to the suitable physician for treatment. The VCN helps patients understand their diagnosis, provides education, assesses barriers to care, connects to resources, provides emotional support, and offers assistance with follow-up for physician visits, imaging and procedures such as colonoscopies, based upon NCCN Guidelines and physician guidelines. The VCN also connects stage III/IV patients with an on-site navigator in their region for more hands-on navigation. Results: Through September 2018, Sarah Cannon navigated 734 colon cancers, 332 stage I/II and 402 stage III/IV. With our increased capacity, Sarah Cannon/HCA maintained a 98% rate of follow-up care with new diagnoses of all stages of colon cancer. Conclusions: The VCN program allowed Sarah Cannon/HCA to improve care continuity and compliance based upon NCCN Guidelines for early stage I/II colon cancer patients throughout 5 regions and 37 facilities.

NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 2.2019

2019 ◽  
Vol 17 (9) ◽  
pp. 1032-1041 ◽  
Author(s):  
Samir Gupta ◽  
Dawn Provenzale ◽  
Xavier Llor ◽  
Amy L. Halverson ◽  
William Grady ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Assessment ◽  
High Risk ◽  
Hereditary Colorectal Cancer ◽  
Cancer Surveillance ◽  
Nccn Guidelines ◽  
Hereditary Syndromes ◽  
Hereditary Colorectal Cancer Syndromes ◽  
Cancer Syndromes ◽  
Familial High Risk

Identifying individuals with hereditary syndromes allows for improved cancer surveillance, risk reduction, and optimized management. Establishing criteria for assessment allows for the identification of individuals who are carriers of pathogenic genetic variants. The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the assessment and management of patients with high-risk colorectal cancer syndromes. These NCCN Guidelines Insights focus on criteria for the evaluation of Lynch syndrome and considerations for use of multigene testing in the assessment of hereditary colorectal cancer syndromes.

TFAP2E methylation status and prognosis of patients with radically resected colorectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3628-3628
Author(s):  
Seong Joon Park ◽  
Seung-mi Kim ◽  
Yong Sang Hong ◽  
Jae-Lyun Lee ◽  
Jeong-Eun Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Methylation Status ◽  
Stage I ◽  
Gene Encoding ◽  
Free Survival ◽  
Factors Affecting ◽  
Distal Location ◽  
Resected Stage ◽  
Significant Factors

3628 Background: Transcription factor AP-2ε, a member of the AP-2 family has extensively studied in many cancers. Recently, it has been suggested that the gene encoding AP-2ε (TFAP2E) is involved in the development of colorectal cancer (CRC) and is also associated with clinical outcomes of the patients with CRCs. Therefore, we have investigated the clinical significance of TFAP2E in CRC patients who underwent curative resections. Methods: A single-institution cohort of 248 patients with curatively resected, stage I/II/III CRCs between March and December, 2004 were included, and the analyses were performed in 193 patients whose tumors were available for TFAP2E methylation status Results: One hundred twelve patients (58%) showed TFAP2E hypermethylation, which was significantly more common in CRCs with distal location, low pathologic T stage (T1/T2) and stage I. After a median follow-up duration of 86.3 months, the patients with TFAP2E hypermethylation had a trend for better survival outcome in terms of relapse-free survival (RFS) and overall survival (OS) (TFAP2E hypermethylation vs. hypomethylation; 5-year RFS rate 90% vs. 80%, p=0.063; 6-year OS rate 88% vs. 80%, p=0.083). Multivariate analysis showed pathologic nodal stage and TFAP2E methylation status were independent prognostic factors affecting both RFS and OS, which also remained significant factors in the subgroup analysis including 154 patients with stage II/III CRCs who had received adjuvant chemotherapy. Conclusions: TFAP2E hypermethylation was associated with better clinical outcome and may be considered as an independent prognostic factor in the patients with curatively resected CRC.

Intensive CT scan surveillance for patients who have undergone curative intent treatment for colorectal cancer: The Medstar Washington Hospital Center experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14675-e14675 ◽  
Author(s):  
Konstantinos Leventakos ◽  
Stanlee Santos Lu ◽  
David John Perry
Keyword(s):  
Colorectal Cancer ◽  
Ct Scan ◽  
Survival Data ◽  
Stage I ◽  
First Year ◽  
Curative Intent ◽  
Serial Measurement ◽  
A Prospective Study ◽  
Hospital Center

e14675 Background: The current ASCO guideline for surveillance after curative intent treatment of colorectal cancer is yearly CT scan of the chest, abdomen and pelvis with every 3-6 months history and physical exam and serial measurement of Carcinoembryonic antigen (CEA). The benefit of doing more intensive CT scan surveillance has not been adequately substantiated. Methods: Data of patients with resectable stage I-III colorectal cancer treated at Medstar Washington Hospital Center from January 2000-June 2012 were retrospectively reviewed. Epidemiologic, histopathologic , surveillance schedule (CT scan and CEA), and survival data were analyzed. Our institutional standard was to obtain CT scans every 3 months for the first year, every 6 months for the second year and then yearly for years 3-5. Results: Thirty-three patients with adequate documentation were included. The mean age of the patients was 59.6 years at diagnosis, 55% were female and 78% ethnically African American. 6% were in stage I, 37% were in stage II and 57% in stage III. CT scan was used in 100% of the patients done with a median interval of 7 months. At follow up, 28 (85%) patients had recurrence at a median of 21.6 months from surgery. 67% had recurrence in the liver. 96% of these recurrences were diagnosed primarily by CT scan and only 1 patient (3%) was diagnosed with MRI of the liver following an elevated CEA with a negative CT scan. Only 50% of patients with recurrence had an elevated CEA. 54% of patients with recurrence were able to undergo curative treatment (resection and/or chemotherapy). Conclusions: In this single institution, retrospective review, CT scan surveillance was utilized more frequently than specified in current ASCO guidelines. CEA screening alone would have missed 50% of patients with potentially curable recurrent cancer. Our data shows that more intensive CT scan surveillance led to earlier detection of recurrences that allowed patients to undergo curative intent treatment. A prospective study is warranted to further support this finding.

Stage-based variation in the impact of colon cancer surveillance.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3609-3609
Author(s):  
Lucy Gately ◽  
Christine Semira ◽  
Azim Jalali ◽  
Ian Faragher ◽  
Sumitra Ananda ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Recurrence Rate ◽  
Cancer Surveillance ◽  
Stage I ◽  
Stage At Diagnosis ◽  
Recurrence Rates ◽  
Curative Intent ◽  
Oligometastatic Disease ◽  
The Impact

3609 Background: Multiple meta-analyses have demonstrated that routine surveillance following curative intent colorectal cancer surgery improves overall survival. This benefit is largely driven by early detection and curative intent resection of oligometastatic disease. Intuitively, any surveillance benefit should be proportional to recurrence risk, leading some to question the value of surveillance for stage I patients where recurrence rates are low. However, the survival benefit of surveillance has not previously been reported by stage. Methods: We explored data from a multi-site cohort of colorectal cancer patients (pts) diagnosed from 1 January 2001 to 31 December 2016. Pts were followed according to standard protocols with a standardized comprehensive outcome data captured prospectively. Pts with a rectal primary or metastatic disease at presentation were excluded from the analysis. We examined the correlation of stage at diagnosis with tumor recurrence and subsequent outcomes. Results: Of 3608 colon cancer pts, 690 (19%) had stage 1, 1580 (44%) had stage 2, and 1338 (37%) had stage 3 disease. Median follow-up was 7.8 years. Stage at diagnosis impacted recurrence rate (4% stage I vs 12% stage II vs 28% stage III, p < .0001) but not median time to recurrence. Recurrence patterns varied with stage (e.g. distant nodal disease 5% vs 7% vs 16%, p = .003; liver metastases 90% vs 53% vs 42%, p = 0.001). In pts with recurrence, resection of oligometastatic disease varied significantly by stage (58% vs 42% vs 30%, p < .0001) as did post-resection 5 year survival (91% vs 66% vs 43%, p < 0.001). In pts with recurrence treated with palliative intent, stage at diagnosis also impacted post-recurrence 5 year survival (11% vs 7% vs 5%, p < 0.03). Conclusions: Colon cancer stage at diagnosis substantially impacts the proportion of pts able to undergo curative intent surgery for surveillance detected recurrent disease, potentially driven by stage specific metastatic patterns. Stage at diagnosis also has a significant impact on post-resection survival outcomes potentially driven by stage specific biology. Our data indicate a far greater survival impact of surveillance for stage I colon cancer than would be anticipated based on recurrence rate alone.

Identification of stage I/II colorectal cancer patients at risk of recurrence: The role of elastica stains to detect venous invasion.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14117-e14117
Author(s):  
Campbell SD Roxburgh ◽  
Alan K Foulis ◽  
Manal Atwan ◽  
Paul G Horgan ◽  
Donald C. Mcmillan
Keyword(s):  
Colorectal Cancer ◽  
At Risk ◽  
High Risk ◽  
Venous Invasion ◽  
Stage I ◽  
Low Grade ◽  
Cancer Specific Survival ◽  
Node Negative ◽  
Risk Of Recurrence

e14117 Background: Venous invasion (VI) is a high-risk characteristic in colorectal cancer (CRC) and in stage II disease guides provision of adjuvant therapy. However, reported rates vary in published studies from 10-90%. We recently reported use of elastica stains improve reproducibility of reporting, increasing rates to >50% (Roxburgh, Ann Surg, 2010). Furthermore, compared to H&E alone, elastica detected VI provided superior prediction of 3yr cancer survival in an unselected cohort of CRC patients. The present study aims to examine how the approach could be used in patients with node negative CRC. Methods: We retrieved pre-2003 tumour blocks, sectioned and stained them with elastica. Post-2003, elastica detected VI was routinely reported. A minimum of 3 blocks was required for analysis. Those who died within 30 days of surgery or had neoadjuvant therapy were excluded. Results: 244 stage I/II patients underwent surgery between 1997-2006. 65 cases pre-2003 were analyzed retrospectively. The rate of elastica detected VI was 54%. Elastica detected VI related to other high-risk pathology including T stage (p<0.001), serosal invasion (p<0.01), tumour grade (p<0.05) and low-grade lymphocytic infiltrate (P<0.05). Minimum follow-up was 5 yrs; mean follow-up 99 months (60-178), during which there were 99 deaths, 48 from cancer. Absence of VI related to improved 5-yr cancer specific survival (93% vs 66%). On multivariate analysis, VI independently related to cancer specific survival (HR=5.5,95%CI 2-13,p<0.001) with margin involvement (HR=2.4,95%CI 1-6,p=0.067) and serosal involvement (HR=2.2,95%CI1-4, p=0.015). For CRC mortality, the area under the receiver operator curve was highest for VI compared with other pathology (AUC 0.69, 95%CI 0.6-0.8, P<0.001). Absence of VI related to 5-yr survivals of 92% and 97% in colon and rectal cancer respectively. Conclusions: More objective assessment of VI with routine elastica staining provides accurate prediction of survival in stage I/II CRC. Presence of VI was associated with a 5.5 fold increased risk of cancer death at 5 yrs. Such results support routine use of elastica stains to identify patients with node negative disease at risk of recurrence.

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