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Half of Colorectal Cancer Survivors Not Getting Recommended Colonoscopies

Despite guidelines calling for a colonoscopy a year after surgery for colon or rectal cancer, less than half of patients have had one 14 months after colorectal surgery intended to cure their cancer.

A study of stage I, II, and III colorectal cancer patients in the United States found that only 49 percent had received the recommended colonoscopy.

Currently follow-up guidelines call for a surveillance colonoscopy to look for local cancer recurrence or new polyps or cancers a year after surgery.  If that exam is normal, another colonoscopy is called for three years later and then every five years. 

Researchers talked to 1,400 colorectal cancer survivors in the Cancer Care Outcomes Research and Surveillance (CanCORS) study and examined their medical records.  Patients in the study had been diagnosed with colon or rectal cancer between 2003 and 2005.  They all had surgery for stage I, II, or III colorectal cancer and were alive 14 months later.

CanCORS includes lung and colorectal cancer patients in a collaborative study including four geographic areas across the United States, 15 Veterans Administration sites, and 5 members of the Cancer Research Network, a network of managed care organizations designated by the National Cancer Institute to conduct research on cancer prevention and control.

Patients were more likely to have received a surveillance colonoscopy by 14 months after surgery if they:

  • had colon versus rectal cancer.
  • were seen by a medical oncologist.
  • saw a primary care provider in the year after their cancer diagnosis.
  • had stage I versus stage III cancer.
  • had no other serious medical conditions.

Rates varied significantly depending on the site where care was received from 37 percent to 57 percent.  It was lowest in managed care organizations.

The study authors considered whether or not there was confusion as to who should order a follow-up colonoscopy.  They wrote,

With the often fragmented care of cancer survivors, it may be unclear who is responsible for ensuring adherence to colonoscopy guidelines. Oncologists, primary care providers, and other providers involved in the care of CRC survivors must communicate with each other about their separate responsibilities for detecting second primary cancers.

They said that it is important to know if colorectal cancer survivors are receiving a survivorship plan, as recommended by the Institute of Medicine, whether they understand it, and whether they are sharing it with their primary care providers.

In conclusion, Talya Salz and the study team wrote,

Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.

SOURCE: Salz et al., BMC Health Services Research, Volume 10, September 1, 2010.

What This Means for Patients

A colonoscopy a year after surgery is important for stage I, II, and III colon and rectal cancer patients. It can detect a local recurrence at the site of the surgery and, perhaps, a new polyp at other places within the colon.  People who have had one colorectal cancer are at higher risk for another one.

Post cancer surgery surveillance guidelines call for a colonoscopy at 1 year, and — if normal — 3 years later and then at 5 year intervals.

If polyps are found or if the patient has Lynch syndrome, more frequent exams are necessary.

If, for some reason, the entire colon wasn’t examined with a colonoscopy before surgery, a colonoscopy to clear all polyps should be done 3 to 6 months after surgery.  This might happen if there was an obstruction in the colon and the scope couldn’t reach beyond it.

Make sure that your doctors are aware of the need for colonoscopies after your colorectal cancer surgery and that you get prompt referrals for them.  Ask for a written survivorship plan when you finish treatment, whether that is after surgery or chemotherapy.

Following the examination at 1 year, the intervals before subsequent examinations may be shortened if there is evidence of hereditary nonpolyposis colorectal cancer or if adenoma findings warrant earlier colonoscopy.

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