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.

Early survival outcomes in stage I-III operated colon cancer patients from a low prevalence, lower-middle income country: The Indian experience.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 857-857
Author(s):  
Rushabh Kiran Kothari ◽  
Vikas S. Ostwal ◽  
Anant Ramaswamy ◽  
Tara Chand Gupta ◽  
Sandeep Kumar Bairwa ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Survival Outcomes ◽  
Middle Income ◽  
Colon Cancers ◽  
Low Prevalence

857 Background: Data regarding survival and outcomes in operated colon cancer patients from a lower-middle income and low prevalence nation like India is scarce. Methods: Patients who underwent curative resection for non-metastatic, non-rectal colon cancer from January 2013 to December 2016 were retrospectively analyzed from a prospectively maintained database for baseline demographics, disease characteristics, adjuvant chemotherapy, recurrence free survival (RFS) and overall survival (OS). RFS and OS were calculated by Kaplan Meier method. Results: 505 patients underwent resection in the pre-defined time-period. Median age of the patients was 53 years (range: 17 – 87) and 339 patients (67.3%) were male. Patients with stage I, stage II and stage III disease were 43(8.6%), 233(46.1%) and 217(42.9%), respectively, while 12 patients(2.4%) were not adequately staged, though non-metastatic. Right sided colon cancers were more prevalent as compared to left sided (56% vs. 44%) and 41 patients (8%) had signet ring adenocarcinoma on cytomorphology. Median number of nodes retrieved during surgery was 22 nodes(range:1-96 ). Adjuvant chemotherapy was planned for 406 patients (80.4%), with the common regimens used being capecitabine-oxaliplatin, capecitabine , 5-fluorouracil – oxaliplatin and 5-fluorouracil in 280 (55.2%), 80 (16%), 34 (7%) and 6 patients (1.2%), respectively. Planned adjuvant chemotherapy was completed in 334 patients(82.3%; n = 406) with 27 patients (6%) required dose reduction. 35 patients (7%) required permanent cessation of adjuvant treatment due to chemotherapy related toxicity. With a median follow up of 21.8 months (range: 0-56),estimated 3 year RFS for the entire cohort was 86.2% and estimated median OS was 95.2%. Estimated RFS in stage I, Stage II, stage III patients were 90.3%, 89.5% and 78% respectively (p-0.006). Conclusions: Early survival outcomes with Stage I-III colon cancers in a low prevalence country like India appears to be comparable or potentially superior to outcomes published from high prevalence countries. Adjuvant chemotherapy in Stage II and Stage III colon cancers in a real world scenario in India appears to be well tolerated.

Prognostic impact of preoperative albumin to globulin ratio in curative colon cancer patients.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 647-647
Author(s):  
Yuji Toiyama ◽  
Hiroyuki Fujikawa ◽  
Yasuhiro Inoue ◽  
Hiroki Imaoka ◽  
Masato Okigami ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Poor Prognosis ◽  
Early Recurrence ◽  
Stage I ◽  
Stage Iii ◽  
Prognostic Impact ◽  
Stage Iii Colon Cancer ◽  
Albumin To Globulin Ratio

647 Background: Albumin to globulin ratio (AGR) has been reported to predict long term mortality in patients with several cancers. However, prognostic impact of preoperative AGR in colon cancer patients with curative intent has not yet been fully addressed. Therefore, we, for the first time, investigated the association between AGR and clinico-pathological findings including overall survival (OS) and disease free survival (DFS) in stage I-III colon cancer patients. Methods: Clinicopathological findings including preoperative laboratory data (carcinoembryonic antigen [CEA] and AGR) from 251 curative colon cancer patients were assessed as indicators of early recurrence and poor prognosis in this retrospective study. AGR was calculated as [AGR = albumin/ (total protein - albumin)]. The cut-off value of AGR was 1.32 in current study. Results: Several clinicopathological categories related with tumor progression such as lymph node metastasis, T4 tumor, large tumor size, undifferentiated tumor, venous and lymphatic invasion, and high CEA were significantly associated with low AGR level. The patients with low AGR were significantly poorer OS (P = 0.001) and DFS (P = 0.003) than those with high AGR, respectively. In addition, multivariate analyses demonstrated that low AGR was independently associated with early recurrence (HR = 2.87, P = 0.007) and poor prognosis (HR = 2.56, P = 0.008), respectively. On the other hand, sub analysis of survival curves revealed that stage III colon cancer patients with low AGR were significantly poorer OS (P = 0.007) and DFS (P = 0.02) than those with high AGR, respectively. Furthermore, significantly poorer OS and DFS were also shown in stage I-II colon cancer patients with low AGR, respectively (OS: P = 0.02, DFS: P = 0.01). Conclusions: Preoperative AGR was an independent predictor of early recurrence and poor prognosis in curative colon cancer patients. AGR may represent a simple, potentially useful predictive biomarker for selecting stage I-II colon cancer patients who might need adjuvant chemotherapy. Furthermore, AGR may select candidates who are better to introduce more intensive adjuvant chemotherapy after curative operation in stage III colon cancer patients.

scholarly journals Anterior Gradient-2 (AGR2) overexpression in colon cancer: a potential prognostic biomarker

2021 ◽  
Author(s):  
Delphine Fessart ◽  
Isabelle Mahouche ◽  
Veronique Brouste ◽  
Valerie Velasco ◽  
Isabelle Soubeyran ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Protein Expression ◽  
Cancer Patients ◽  
Causes Of Death ◽  
Early Stage ◽  
Tumour Microenvironment ◽  
Tissue Samples ◽  
Colon Cancers ◽  
Mrna And Protein Expression ◽  
Protein Disulfide

AbstractAimsColon cancer is one of the most common leading causes of death worldwide. Prognostic at an early stage is an efficient way to decrease mortality. The Endoplasmic Reticulum (ER)-resident protein anterior gradient-2 (AGR2), a Protein Disulfide Isomerase (PDI) is highly expressed in various solid tumours and is involved in tumour microenvironment-associated processes such as tumour growth, invasion and metastasis. This study aims at examining the expression of AGR2 protein in colon cancer as its prognostic value in such cancer remains inconclusive.MethodsAGR2 protein expression was determined using immunohistochemistry on human tissue samples issued from a cohort of 82 colorectal carcinomas (Institut Bergonié, Bordeaux, France).ResultsAGR2 protein expression was significantly higher in tumours than in adjacent non-tumour controls. AGR2 expression subgroup analyses indicated that AGR2 low expression in colon cancer patients was significantly associated with worse overall survival. Mucinous colon cancers exhibited higher AGR2 expression levels than non-mucinous cancers. Additionally, tumours with microsatellite instability (MSI) were characterised by a strong upregulation of AGR2 mRNA and protein expression despite an absence of MLH1/MSH2 mutations.ConclusionOur findings indicate that high AGR2 protein expression is correlated with longer patient survival and that AGR2 overexpression is associated with MSI and mucinous-type colorectal cancers. Overall, AGR2 might serve as a biomarker to stratify colon tumours and to contribute to the prognosis of colon cancer patients.

Microsatellite instability predicts improved response to adjuvant therapy with irinotecan, 5-fluorouracil and leucovorin in stage III colon cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10003-10003 ◽  
Author(s):  
M. M. Bertagnolli ◽  
C. C. Compton ◽  
D. Niedzwiecki ◽  
R. S. Warren ◽  
S. Jewell ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Microsatellite Instability ◽  
Statistical Significance ◽  
Disease Free Survival ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Colon Cancers ◽  
Early Results ◽  
The Impact

10003 Background: Colon cancers exhibiting a high level of microsatellite instability (MSI-H) show distinct clinicopathological features, including both better prognosis and reduced response to 5-fluorouracil (5-FU)-based chemotherapy. We investigated the impact of adjuvant chemotherapy containing irinotecan in patients with MSI-H colon cancers. Methods: CALGB protocol 89803 randomized 1264 patients with resected stage III colon cancer to receive post-operative 5-FU and leucovorin (LV) with or without irinotecan. Paraffin blocks containing primary tumor and normal tissue were collected. Microsatellite instablility was assessed using a panel of mono- and di-nucleotide markers. Disease free survival (DFS) was measured from trial entry until documented disease progression or death from any cause. A statistical significance level of 0.2 was used in screening to generate hypotheses regarding MSI status and outcome. Median follow-up at analysis was 3.8 years. Overall C89803 showed no advantage for addition of irinotecan to 5-FU/LV. Results: Patients with and without tumor samples analyzed did not differ by treatment, age, gender, primary site, T-stage, differentiation, # positive nodes, or mucinous type. Of 482 tumors analyzed, 75 (16%) demonstrated MSI-H. MSI-H cancers were more likely to be located in the proximal colon (p<0.0001), of high histologic grade (p<0.0001) and mucinous histology (p<0.0001), and also had increased numbers of tumor-containing lymph nodes (mean # positive nodes/case = 3.5 for MSI Low/Stable vs. 4.7 for MSI-H; p = 0.04). At the time of analysis 143 of 482 patients (36%) analyzed experienced tumor recurrence and/or death due to any cause. For patients with MSI-H tumors, DFS was better in those treated with irinotecan in addition to 5-FU/LV (logrank p=0.18). Among patients with MSI Low/Stable tumors there was no difference in DFS between those treated with and without irinotecan (logrank p =0.39). Conclusions: Early results from CALGB protocol 89803 indicate that addition of postoperative irinotecan to 5-FU/LV may improve DFS in patients with stage III colon cancers that exhibit MSI-H. Longer follow-up is required to confirm this finding. [Table: see text]

scholarly journals Factors Associated With Follow-Up Care Among Women With Early-Stage Breast Cancer

2019 ◽  
Vol 15 (1) ◽  
pp. e1-e9
Author(s):  
Farah F. Quyyumi ◽  
Jason D. Wright ◽  
Melissa K. Accordino ◽  
Donna Buono ◽  
Cynthia W. Law ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Stage I ◽  
Early Stage Breast Cancer ◽  
Radiation Oncologist ◽  
Medical Oncologist ◽  
Data Set ◽  
Factors Associated ◽  
Follow Up Care

PURPOSE: Follow-up guidelines vary widely among national organizations for patients with early-stage breast cancer treated with curative intent. We sought to evaluate the patterns and predictors of provider follow-up care within the first 5 years after diagnosis. METHODS: Using the SEER-Medicare linked data set, we evaluated patients who were diagnosed with stage I and II breast cancer who underwent breast-conserving surgery from 2002 to 2007 with follow-up until 2012. We defined discontinuation of follow-up as > 12 months from the previous physician visit without a visit claim from either a surgeon, medical oncologist, or radiation oncologist. We performed a multivariable logistic regression and Cox proportional hazards regression analysis to determine factors associated with the discontinuation of follow-up care. RESULTS: Of the 30,053 patients enrolled in our initial cohort, 25,781 (85.8%) saw a medical oncologist and 21,612 (71.9%) saw a radiation oncologist in the first year in addition to a surgeon. Over the 5 years, 6,302 patients (21.0%) discontinued follow-up visits. Discontinuation of physician visits increased with increasing age. Women with stage II cancer ( v stage I) were less likely to discontinue follow-up visits (odds ratio, 0.78; 95% CI, 0.73 to 0.83). Time to early discontinuation was greater for patients with hormone receptor–negative tumors (hazard ratio, 1.14; 95% CI, 1.05 to 1.24). Women who were diagnosed more recently were less likely to discontinue seeing any physician. CONCLUSION: Twenty-one percent of patients with early-stage breast cancer discontinued seeing any oncology provider over the 5 years after diagnosis. Coordination of follow-up care between oncology specialists may reduce discontinuation rates and increase clinical efficiency.

scholarly journals Rationale and design of the POLEM trial: avelumab plus fluoropyrimidine-based chemotherapy as adjuvant treatment for stage III mismatch repair deficient or POLE exonuclease domain mutant colon cancer: a phase III randomised study

ESMO Open ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. e000638 ◽  
Author(s):  
David Lau ◽  
Eleftheria Kalaitzaki ◽  
David N Church ◽  
Hardev Pandha ◽  
Ian Tomlinson ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Mismatch Repair ◽  
Early Stage ◽  
Randomised Trial ◽  
Disease Free Survival ◽  
Phase Iii ◽  
Stage Iii ◽  
Colon Cancers ◽  
Exonuclease Domain ◽  
The Uk

Background10%–15% of early-stage colon cancers harbour either deficient mismatch repair (dMMR), microsatellite instability high (MSI-H) or POLE exonuclease domain mutations, and are characterised by high tumour mutational burden and increased lymphocytic infiltrate. Metastatic dMMR colon cancers are highly sensitive to immune checkpoint inhibition, and recent data show POLE-mutant tumours are similarly responsive. We are conducting a phase III randomised trial to determine if the addition of the anti-PD-L1 antibody avelumab following adjuvant chemotherapy improves disease-free survival (DFS) in patients with stage III dMMR/MSI-H or POLE mutant colon cancer and is a cost-effective approach for the UK National Health Service (NHS).MethodsWe are recruiting patients with completely resected, stage III colon cancer confirmed to have dMMR/MSI-H, locally or POLE exonuclease domain mutation on central testing. Eligible patients are randomised in a 1:1 ratio to standard fluoropyrimidine-based chemotherapy (capecitabine, oxaliplatin for 12 weeks or capecitabine for 24 weeks) or chemotherapy, followed by avelumab (10 mg/kg, 2 weekly for 24 weeks). Stratification is by chemotherapy received and MMR/MSI-H status. The primary endpoint is DFS. Secondary endpoints include overall survival, toxicity, quality of life and health resource use. The 3-year DFS rate in the control arm is expected to be ~75%. Avelumab is expected to improve the 3-year DFS rate by 12% (ie, 87%). Target accrual is 402 patients, which provides 80% power to detect an HR of 0.48 for DFS at a two-sided alpha of 0.05. This national, multicentre phase III trial is sponsored by the Royal Marsden NHS Foundation Trust and it is anticipated that approximately 40 centres in the UK will participate. This study opened to recruitment in August 2018.Trial registration numberNCT03827044

scholarly journals Adherence to Stage-Specific Treatment Guidelines for Patients With Colon Cancer

2012 ◽  
Vol 30 (9) ◽  
pp. 972-979 ◽  
Author(s):  
Ryaz Chagpar ◽  
Yan Xing ◽  
Yi-Ju Chiang ◽  
Barry W. Feig ◽  
George J. Chang ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Treatment Guidelines ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Disease Stage ◽  
Nccn Guidelines ◽  
Factors Associated ◽  
The Impact

Purpose Adherence to evidence-based treatment guidelines has been proposed as a measure of cancer care quality. We sought to determine rates of and factors associated with adherence to the National Comprehensive Cancer Network (NCCN) treatment guidelines for colon cancer. Patients and Methods Patients within the National Cancer Data Base treated for colon adenocarcinoma (2003 to 2007) were identified. Adherence to stage-specific NCCN guidelines was determined based on disease stage. Hierarchical regression analyses were performed to identify factors predictive of adherence, overtreatment, and undertreatment. Results A total of 173,243 patients were included in the final cohort, 123,953 (71%) of whom were treated according to NCCN guidelines. Patients with stage I disease were more likely to receive guideline-based treatment (96%) than patients with stage II (low risk, 66%; high risk, 36%), III (71%), or IV (73%) disease (P < .001). Adherence to consensus-based guidelines increased over time. Factors associated with adherence across all stages included age, Charlson-Deyo comorbidity index score, later year of diagnosis, and insurance status. Among patients with high-risk stage II or stage III disease, older patients with pre-existing comorbidities and patients with lower socioeconomic status were less likely to be offered adjuvant chemotherapy. Among patients with stage I and II disease, young, healthy patients were more likely to be recommended chemotherapy, in discordance with NCCN guidelines. Conclusion Significant variation exists in the treatment of colon cancer, particularly in treatment of high-risk stage II and stage III disease. The impact of nonadherence to guidelines on patient outcomes needs to be further elucidated.

scholarly journals Long - term follow - up results of single port laparoscopic colectomy for colon cancers

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Trung Vỹ Phạm ◽  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Single Port ◽  
Surgical Techniques ◽  
Stage I ◽  
Stage Ii ◽  
Stage Iii ◽  
Long Term Results

Tóm tắt Mục tiêu: Đánh giá kết quả phẫu thuật nội soi một cổng (PTNSMC) ung thư đại tràng có theo dõi và đánh giá kết quả sống còn sau mổ. Đối tượng nghiên cứu: Nghiên cứu tiến cứu gồm 114 người bệnh (NB) ung thư đại tràng (UTĐT) được phẫu thuật nội soi một cổng từ tháng 12/2011 được theo dõi đến tháng 12/2018 tại Bệnh viện Trung ương Huế. Kết quả: Tuổi trung bình (TB) 57,1 ± 14,2 tuổi (25 - 87), tỷ lệ nam/nữ 1,6/1, tăng CEA trước mổ 54,4%, kích thước u TB 4,9 ± 2,5cm (1 - 7,5). Phương pháp phẫu thuật: cắt nửa đại tràng phải 73,7%, cắt nửa đại tràng trái 14,9%, cắt đoạn đại tràng sigma 11,4%, đặt thêm 1 trocar hỗ trợ 16,7%, không có tử vong cũng như các tai biến trong mổ. Thời gian phẫu thuật 163,5 ± 75,5 phút (120 - 290), số hạch thu được 16,2 ± 4,5 hạch (12 - 25), thời gian nằm viện 7,5 ± 6,1 ngày (6 - 15). Giai đoạn (GĐ): GĐ1: 30,7%; GĐ2: 43,9%; GĐ3: 25,4%. Thời gian theo dõi 38,2 ± 17,5 tháng (6 - 84), 5 NB tái phát tại vùng 4,4%, 3 NB tiến triển di căn xa 2,6%. Sống còn toàn bộ sau 2 năm 96,2%, sau 5 năm 75,7%, sống còn 5 năm theo giai đoạn: GĐ1: 90,9%; GĐ2: 71,6%; GĐ3: 20,8% (p< 0,0001). Kết luận: Phẫu thuật nội soi một cổng ung thư đại tràng là khả thi và an toàn, giá trị thẩm mỹ là vết rạch ngắn, được che phủ bởi rốn. Kết quả lâu dài về mặt ung thư học là tương tự với phẫu thuật nội soi truyền thống trong ung thư đại tràng. Abstract Objectives: Evaluation of results of single port laparoscopic surgery (SPLS) for colon cancer with follow up of survival. Materials and methods: Prospective study of 114 patients suffering from colon cancer underwent SPLS from December 2011, were followed up until December 2018 at Hue Central Hospital. Results: Average age was 57.1 ± 14.2 years (25 - 87), male/female was 1.6/1, pre-operative elevated level of CEA was 54.4%, average tumor size 4.9 ± 2.5cm (1 - 7.5). Surgical techniques included right hemicolectomy 73.7%, left hemicolectomy 14.9% and sigmoidectomy 11.4%, additional one more trocar was 16.7%. No death and nor complications were observed during surgery. Time of surgery was 163.5 ± 75.5 minutes (120 - 290), mean lymph nodes harvest 16.2 ± 4.5 nodes (12 - 25), mean hospital lenght stay was 7.5 ± 6.1 days (6 - 15). Stage I: 30.7%; stage II: 43.9%; stage III: 25.4%. Follow-up time was 38.2 ± 17.5 months (6 - 84), local recurrence was in 5 patients accounted for 4.4%, 3 patients with distal metastasis 2.6%, overall survival rates after 2 years accounted for 96.2%, after 5 years in 75.7%, 5 years of survival according to stage were : stage I in 90.9%, stage II in 71.6%, stage III in 20.8% (p <0, 0001). Conclusion: Single port laparoscopic surgery for colon cancer is feasible and safe, cosmetic aspect is a short incision, hidden by the umbilicus. Long-term results in oncology are equivalent to conventional laparoscopic surgery. Keywords: Colon cancer, Single port laparoscopic surgery.

scholarly journals Genomic profiling of stage II and III colon cancers reveals APC mutations to be associated with survival in stage III colon cancer patients

Oncotarget ◽  
2016 ◽  
Vol 7 (45) ◽  
pp. 73876-73887 ◽  
Author(s):  
Evert van den Broek ◽  
Oscar Krijgsman ◽  
Daoud Sie ◽  
Marianne Tijssen ◽  
Sandra Mongera ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cancer Patients ◽  
Stage Ii ◽  
Stage Iii ◽  
Genomic Profiling ◽  
Stage Iii Colon Cancer ◽  
Colon Cancers ◽  
Apc Mutations

Minimal effect of initial TNM stage on follow-up intensity for rectal cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14508-14508
Author(s):  
K. Ode ◽  
K. S. Virgo ◽  
W. E. Longo ◽  
R. A. Audisio ◽  
F. E. Johnson
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Radical Surgery ◽  
Tnm Stage ◽  
Stage I ◽  
Stage Iii ◽  
Office Visits ◽  
Curative Intent

14508 Background: For rectal cancer patients, the risk of recurrence after curative-intent treatment is directly related to initial tumor stage. It is often assumed that more intensive follow-up is worthwhile in patients with high TNM stage lesions, while less intensive follow- up is sufficient for those with low TNM stage cancers. We carried out a survey of members of the American Society of Colon and Rectal Surgeons (ASCRS) to determine the surveillance strategies they use after primary curative-intent treatment for their own patients. This report describes the variation in surveillance intensity ascribable to initial TNM stage. Methods: We created a series of 4 vignettes succinctly describing generally healthy patients with rectal carcinoma (stage I treated with local excision, stage I treated with radical surgery, stage II treated with radical surgery, and stage III treated with radical surgery ± adjuvant therapy). We mailed a questionnaire based on the vignettes to all 1,795 members of ASCRS. Evaluable replies were entered into a computer database. The effect of TNM stage on follow-up intensity was analyzed using repeated-measures ANOVA. Results: There were 566 responses (32%), among which 347 (61%) were evaluable. The most frequent surveillance modality was office visit. In post-operative year 1 for patients with stage I lesions treated with local therapy, 3.8 ± 1.4 office visits (mean ± SD) were recommended, decreasing to 1.5 ± 0.8 in year 5. For patients with stage III lesions treated with radical surgery ± adjuvant therapy, 4.0 ± 2.8 office visits were recommended in year 1, decreasing to 1.7 ± 1.2 in year 5. Similar results were generated for all commonly used modalities on the questionnaire (3 blood tests, 2 endoscopic procedures, 8 imaging studies). Conclusions: The intensity of post-operative surveillance following curative-intent treatment for rectal cancer varies minimally by TNM stage. Because of this, a randomized trial of alternate follow-up strategies may be feasible without stratification according to stage. We will present the schema of such a trial at the meeting. No significant financial relationships to disclose.

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