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Abstract
Purpose
The aim of this study was to determine whether recommendations for surveillance carcinoembryonic
antigen (CEA) testing in stage II/III colorectal cancer (CRC) are adhered to upon
discharge from our cancer center, patterns of care after CEA elevation, and whether
differences in outcomes exist between patients who did and did not receive recommended
CEA monitoring.
Patients and Methods
A retrospective, single-institution chart review was completed at the Cross Cancer
Institute (CCI) in Edmonton, Alberta. The Alberta Cancer Registry (ACR) identified
patients with CRC diagnosed between January 1 and December 31, 2001. Patients with
stage II/III CRC seen and/or treated at the CCI and later discharged to the community
with follow-up recommendations based on American Society of Clinical Oncology guidelines
were included. Carcinoembryonic antigen monitoring ≥ every 4 months for ≥ 2 years
was deemed acceptable for study purposes.
Results
The ACR identified 152 stage II/III CRC cases meeting inclusion criteria. Eleven patients
(7.2%) received the minimum predefined CEA follow-up. Eighty-seven CEA follow-up tests
were elevated; only 20 (23%) elevated CEAs were investigated with predefined timely
intervention. Twenty-six patients (17.1%) had documentable tumor recurrence. There
was no difference in overall survival or time to recurrence between the groups who
received and did not receive appropriate follow-up, although small numbers limit the
effectiveness of statistical analysis.
Conclusion
Post-therapy surveillance is important in CRC management. Our study reveals follow-up
recommendations based on best available evidence for interval CEA testing are not
followed in the community. These findings suggest the need for review of recommendations
and change in management for monitoring discharged patients with stage II/III CRC.
Key words
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Article info
Publication history
Accepted:
November 20,
2007
Received in revised form:
November 19,
2007
Received:
September 28,
2007
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© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
