Follow-Up of Patients with Colorectal Cancer A Meta-Analysis (original) (raw)
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Follow-up of patients with colorectal cancer
European Journal of Cancer, 2002
Follow-up after curative treatment of patients with colorectal cancer has as its main aims the quality assessment of the treatment given, patient support, and improved outcome by the early detection and treatment of cancer recurrence. How often, and to what extent, the final aim, improved survival, is indeed realised is so far unclear. A literature search was performed to provide quantitative estimates for the main determinants of the effectiveness of the follow-up. Data were extracted from a total of 267 articles and databases, and were aggregated using modern meta-analytic methods. In order to provide one more colorectal cancer patient with long-term survival through follow-up, 360 positive follow-up tests and 11 operations for colorectal cancer recurrence are needed. In the remaining 359 tests and 10 operations, either no gains are achieved or harm is done. As the third aim of colorectal cancer follow-up, improved survival, is realised in only few patients, follow-up should focus less on diagnosis and treatment of recurrences. It should be of limited intensity and duration (3 years), and the search for preclinical cancer recurrence should primarily be performed by carcino-embryonic antigen (CEA) testing and ultrasound (US). The focus of colorectal cancer follow-up should shift from the early detection of recurrence towards quality assessment and patient support. As support that is as good or even better can be provided by a patient's general practitioner (GP) or by specialised nursing personnel, there is no need for routine follow-up to be performed by the surgeon.
Colorectal cancer follow-up: perspectives for future studies
European Journal of Surgical Oncology (EJSO), 2000
This paper reviews some of the issues involved in the planning and execution of studies to assess the effect of different follow-up strategies for colorectal cancer patients. Mathematical models and many previous studies have failed to indicate strong support for the hypothesis that extensive follow-up leads to an increase in survival rates. In order to assess the best follow-up strategies, at present, within the different Dukes' stages, extremely large trials are required and none of the previous studies have satisfied this criterion, though recently planned studies will, if recruitment targets are met. The large number of patients required, the length of time the study must run, existing accepted follow-up practices in different countries, and the difficulty of managing patients on different follow-up strategies within the same centre all pose problems for the design of a randomized trial. These are not insurmountable, but do contribute to a possible downfall of a large multicentre randomized trial of follow-up strategies. Although such a trial will require considerable international cooperation it will have enormous benefits and implications if it is managed and completed successfully.
Improvement of Survival over Time for Colorectal Cancer Patients: A Population-Based Study
Journal of Clinical Medicine
Purpose: In this study, we analyzed the mortality and survival of colorectal cancer patients in Lithuania. Methods: This was a national cohort study. Population-based data from the Lithuanian Cancer Registry and period analyses were collected. Overall, 20,980 colorectal cancer patients were included. We examined the changes in colorectal cancer mortality and survival rates between 1998 and 2012 according to cancer anatomical sub-sites and stages. We calculated the 5-year relative survival estimates using period analysis. Results: Overall, 20,980 colorectal cancer cases reported from 1998 to 2012 were included in the study. The total number of newly diagnosed colorectal cancers increased from 1998–2002 to 2008–2012 by 12.1%. The highest number of colorectal cancers was localized and increased from 33.9% to 42.0%. The number of cancers with regional metastases and advanced cancers decreased by 11.1% and 15.5%, respectively. An increased number of new cases was observed for almost all ...
International Journal of Surgery, 2007
The prevalence of colorectal cancer is high in the western world and follow-up after treatment of the primary tumour is claimed to consume resources that could be used in improving screening and early diagnosis. Although some patients with recurrent disease can be treated successfully there has been a debate on whether an overall improvement in survival is achieved by follow-up. There is no agreement on a follow-up protocol of investigations. A review via a Medline search of all published studies and reports on the issue of follow-up of colorectal cancer dated from 1975e2006. We examined retrospective and prospective studies, randomised controlled trials, and meta-analyses attempting to identify the optimum follow-up protocol. There is widespread diversity of follow-up policies for colorectal cancer. Follow-up of colorectal cancer does not have a negative impact on Quality of life. There is no evidence that annual colonoscopy provides any survival advantage. It has been shown that intensive follow-up with frequent carcinoembryonic antigen measurement has a survival advantage and is cost-efficient. Similar evidence seems to be gathering about liver imaging with CT scan although it is less conclusive.
Detection of recurrence after surgery for colorectal cancer
European Journal of Cancer, 1995
Of all patients operated for colorectal cancer, 1 in 3 will suffer from cancer recurrence, and most of these patients will die from disseminated disease. Postoperative follow-up aims at improving these grim figures. This sound idea has not been supported by any empirical data. In the current article, we discuss some theoretical issues concerning colorectal cancer follow-up, and present results of a cost-effectiveness analysis, used to model the natural history of colorectal cancer recurrence and the costs and effects of follow-up and re-operation. The expected results of three policies were calculated: no follow-up, selective follow-up and intensive follow-up. For most patients, follow-up will only lead to a significant increase in costs, without increase in (quality-adjusted) life expectancy. Colorectal cancer follow-up is not "evidence-based medicine".
European Journal of Surgical Oncology (EJSO), 2004
Background. The benefit of follow-up for patients after resection of primary colorectal cancer is unproven. The aim of this study was to evaluate the value of a standardised follow-up program considering detection of recurrent disease, eligibility for surgical treatment and survival. Methods. Five hundred and sixty-four patients' records were evaluated. Detection of recurrent disease was distinguished in routine follow up (RF), interval visit (IV) or accidental finding (AF). Results. One hundred and forty-nine patients (26%) had recurrent disease of which 68 were detected by routine follow-up. In 42 patients a resection was performed with curative intent (RF 18, IV 14, AF 10). In 26 patients radical resection (R 0) was possible (RF 13, IV 5, AF 8), seven of them were long-term survivors. Routine follow-up itself had no significant influence on overall survival (PZ0.08), although increased survival was observed if recurrent disease was detected by routine follow-up and resection was performed with curative intent (PZ0.006). Median survival after resection was 4.2 years if recurrent disease was detected during routine follow-up and 0.5 years if detected during interval visits. Conclusions. Patients undergoing resection with curative intent for recurrent disease survive significantly longer if the disease is detected by routine follow-up. Routine follow-up itself did not improve overall survival.
Colorectal cancer prognosis twenty years later
World journal of gastroenterology : WJG, 2010
To evaluate changes in colorectal cancer (CRC) survival over the last 20 years. We compared two groups of consecutive CRC patients that were prospectively recruited: Group I included 1990 patients diagnosed between 1980 and 1994. Group II included 871 patients diagnosed in 2001. The average follow up time was 21 mo (1-229) for Group I and 50 mo (1-73.4) for Group II. Overall median survival was significantly longer in Group II than in Group I (73 mo vs 25 mo, P < 0.001) and the difference was significant for all tumor stages. Post surgical mortality was 8% for Group Iand 2% for Group II (P < 0.001). Only 17% of GroupI patients received chemotherapy compared with 50% of Group II patients (P < 0.001). Survival in colorectal cancer patients has doubled over the past 20 years. This increase seems to be partly due to the generalization in the administration of chemotherapy and to the decrease of post surgical mortality.
Colorectal cancer follow-up: a reassessment of empirical evidence on effectiveness
European Journal of Surgical Oncology (EJSO), 2000
Colorectal cancer is an important cause of death in the Western world, with a propensity of cancer recurrence even after resection with curative intent. Active follow-up has been advocated as a means to detect cancer recurrence at an earlier stage and thereby improve the survival of colorectal cancer patients. The present study assesses published evidence on the effectiveness of follow-up. Articles were obtained from a 20-year Medline search and from cross-references between articles. Articles were included, scored for quality, and extracted by explicit criteria. Regression analysis and chi-squared analysis was performed to assess (1) whether detection of recurrence at earlier asymptomatic disease stage leads to better post-treatment prognosis, and (2) whether active follow-up does improve overall (quality adjusted) survival, as compared to symptom-guided care only. The relationship between disease stage of recurrence (symptoms, number and size) and survival was analysed from 42 articles, 10 of which provided adequate data. Absence of symptoms and small number of recurrence were significantly related to better survival, smaller size insignificantly so. The potential of active follow-up seemed related to a marginally better outcome, larger gains being found in lower quality studies. Available data do suggest that survival gains vary between 0.5 and 2%, 1% seeming to be a best estimate of overall survival gain. Neither the notion that earlier detection of recurrences does significantly improve outcome, nor the hope that active follow-up provides a statistically and clinically significant gain in (quality adjusted) survival, are so far supported by adequate evidence. Colorectal cancer follow-up still fails to meet the criteria for evidence based medicine.
Colorectal cancer survival: Results from a hospital-based cancer registry
Revista Española de Enfermedades Digestivas, 2012
Introduction: colorectal cancer is one of the most common malignancies in developed countries. Data on specific and 10-year survival are scarce. This study analyzes overall and disease-specific survival for patients with colorectal cancer and assesses the value of clinical factors on disease-specific survival. Methods: a retrospective cohort study of newly diagnosed invasive colorectal cancer cases diagnosed from 1992 to 2007 were identified through the Hospital del Mar Cancer Registry. Five-and 10-year survival functions were estimated using Kaplan-Meier method. Cox proportional hazard models were used to assess prognostic factors. Results: a total of 2,080 patients with colorectal cancer were identified. The median age at diagnosis was 72 years and 58.5% were men. By the end of the follow-up period (December 2008), 1,225 patients had died and 68.4% of deaths were due to colorectal cancer. The 5-and 10-year cancer-specific survival rates were 55.5% (95%CI 53.9-57.9%) and 48.5% (95%CI 45.6-51.3%), respectively. The 5-year specific survival rate improved in the last period (2003-2007) (60.4%, 95%CI 55.4-65.0) compared with 1992-1997 (53.4%; 95%CI 49.2-57.4) and 1998-2002 (52.0%; 95%CI 47.8-56.2). Various factors were independently associated with excess CRC mortality: male sex (HR 1.21), age at diagnosis > 75 years (HR 1.97), rectal location (HR 1.33), more advanced stages (stage IV: HR 18.54), poorly differentiated/undifferentiated tumors (HR 1.80), and admission through the emergency department (HR 1.52). Conclusions: cancer-specific survival improved from 1992 to 2007. This improvement could be due to more effective treatment, since changes in stage distribution or age at diagnosis were not observed during the study period. Overall survival rates should notably improve with the implementation of a population-based colorectal cancer screening program in Spain.