Intensive Surveillance following Colorectal Cancer Increases Survival
Colorectal cancer (CRC) ranks second among the leading causes of cancer deaths, and is the third most common cancer among individuals in the US. Most patients who develop recurrent CRC will die from it, thus surveillance for a second or recurrent CRC is important for cancer survivors. Most surveillance programs recommend intensive surveillance in the first 2-3 years after diagnosis, and continued surveillance until approximately 5 years post-diagnosis. This article reviews the clinical trials and evidence that inform the current approach to surveillance among CRC survivors, as well as clinical guidelines developed by various organizations. In addition, authors discuss new technologies and ongoing trials that may inform new surveillance approaches.
Overall, findings suggest that intensive surveillance, particularly in the first 2-3 years of follow-up, appears to be associated with the early detection of recurrences, and thus has a beneficial impact on all-cause survival at five years. Imaging tests of the chest and abdomen have increasingly been recommended by professional organizations, in addition to CEA levels, in order to detect resectable recurrences. However, authors caution that further advancing the intensity of surveillance programs risks increased detection of pseudo-disease, which will not influence patients' health or length of life. In addition, patients with limited life expectancy are unlikely to benefit from intensive surveillance. Authors also point out that in the US, comparative effectiveness trials may be necessary to change healthcare practice and policy because once a test is widely performed, it is difficult to reverse the trend.
Haggstrom D and Imperiale T. A review of surveillance approaches among colorectal cancer survivors. Minerva Gastroenterologica e Dietologica December 2009;55(4):483-500.
Dr. Haggstrom was supported by an HSR&D Career Development Award. Both authors are part of HSR&D's Center on Implementing Evidence-Based Practice in Indianapolis.