Surveillance intensity doesn’t equate to earlier detection, improved survival in colorectal cancer patients
A recent study led by University of Texas MD Anderson Cancer Center researchers found no correlation between intensity of post-treatment surveillance and detection of recurrence or survival in patients with stage I, II or III colorectal cancer (CRC).
“These findings differ from historical data and argue to reconsider current guideline recommendations, in the U.S.,” said corresponding author George J. Chang, MD and professor of Surgical Oncology at MD Anderson in a release.
Most national and international guidelines recommend frequent follow-up testing for CRC patients, but there is little adherence to those standards, resulting in over- and under-testing. In the study, published online May 22 in JAMA, Chang et al. also noted that while surveillance can be effective in long-term care plans, the optimal strategy to go about doing so is unknown.
“There is limited evidence to inform the current guidelines for follow-up testing after curative treatment of colon and rectal cancer and this has resulted in large variations in surveillance guidelines,” authors wrote. “We sought to improve our understanding of the optimal approach to follow-up testing including how often that testing should be done.”
In this retrospective study, authors analyzed data from 8,529 randomly selected adults. The team combined data from the National Cancer Database with medical record data from a Commission on Cancer Special Study to determine the association between surveillance intensity and recurrence or overall survival.
Patients were diagnosed with stage I (25 percent of the cohort), stage II (35.2 percent) and stage III (39.8 percent) CRC. They underwent surgery in 2006 or 2007 and received follow-up in 2014.
Surveillance Intensity was categorized by the frequency of PET, CT or MRI scans and blood tests for the carcinoembryonic antigen (CEA) biomarker during the initial three years of surveillance. High-intensity facilities averaged 2.9 scans and 4.3 CEA tests, and low-intensity was determined to average 1.6 imaging scans and 1.6 CEA tests.
Authors noted the results demonstrated that “intensity of follow-up testing by imaging or CEA was not associated with time to detection of disease recurrence. Additionally, no significant association was identified between surveillance testing intensity and overall survival.”
“As we learn more about the biology and heterogeneity of colorectal cancer, the answer is not always another test,” Chang said in the release. “In addition to added costs, unnecessary testing in cancer patients can lead to treatment toxicity, increased patient anxiety and the potential for false positives, which can lead to patient harm. The data argue that in many cases, a less-intensive surveillance may be a better approach for patients.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.