Receipt of Guideline-recommended Follow-up in Older Colorectal Cancer Survivors A Population-based Analysis
Receipt of Guideline-recommended Follow-up in Older Colorectal Cancer Survivors A Population-based Analysis
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DOI：
10.1002/cncr.23823
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发表时间：
2008-10-15
期刊：
影响因子：
6.2
通讯作者：
Reynolds, Harry L., Jr.
中科院分区：
文献类型：
--
作者：
Cooper, Gregory S.;Kou, Tzuyung Doug;Reynolds, Harry L., Jr.
背景。结直肠癌根治性切除术后，建议进行常规唇部随访、就诊、癌胚抗原 (CEA) 和结肠镜检查。对这些指南的实际遵守情况以及在日常实践中可能过度使用测试的情况尚未得到充分研究。作者在一个链接的肿瘤登记索赔数据库中确定了 9426 名年龄≥ 66 岁的合格患者，这些患者在 2000 年至 2001 年间被诊断患有结肠或直肠腺癌。诊断后对患者进行观察 3 年。每年接受 >= 2 次就诊、每年 >= 2 次 CEA 测试（第一年和第二年）以及 3 年内 >= 1 次结肠镜检查构成指南履行。 结果。分别有 92.3%、73.6% 和 46.7% 的患者符合门诊就诊、结肠镜检查和 CEA 检测指南 此外，分别有 47.7% 和 6.8% 的患者接受了 2 种非推荐程序（腹部/骨盆计算机断层扫描和正电子发射断层扫描）。总体而言，60.2% 的患者接受了低于推荐水平的检测，17.1% 的患者接受了推荐频率的检测，比指南建议高出 22.7%。在多变量分析中，与符合指南相关的因素包括年轻群体、白种人、区域分期癌症和低分化肿瘤。还观察到会议准则存在相当大的地理差异。结论。在这个基于人群的队列中，许多老年结直肠癌幸存者接受的检测频率低于临床实践指南规定的最低频率，特别是在 CEA 方面。进一步的研究应确定依从性差的原因以及对患者结果的影响。癌症 2008；113：2029-37。 (C) 2008 年美国癌症协会。
BACKGROUND. After Curative resection for colorectal cancer, routine follow-Lip with office visits, carcinoembryonic antigen (CEA), and colonoscopy is recommended. The actual adherence to these guidelines as well as the potential overuse of testing in routine practice has not been well studied.METHODS. The authors identified 9426 eligible patients aged >= 66 years in a linked tumor registry-claims database who were diagnosed with adenocarcinoma of the colon or rectum from 2000 to 2001. Patients were observed to 3 years after diagnosis. Receipt of >= 2 office visits per year, >= 2 CEA tests per year (years I and 2), and >= 1 colonoscopy within 3 years constituted guideline fulfillment.RESULTS. Guidelines for office visits, colonoscopy, and CEA testing were met in 92.3%, 73.6%, and 46.7% of patients, respectively In addition, receipt of 2 nonrecommended procedures, abdominal/pelvic computed tomography scans and positron emission tomography scans, was documented in 47.7% and 6.8%, respectively Overall, 60.2% received testing below recommended levels, 17.1% at recommended frequency, and 22.7% above guideline recommendations. In a multivariate analysis, factors associated with meeting guidelines included younger age group, white race, regional stage cancers, and poorly differentiated tumors. Considerable geographic variation in meeting guidelines was also observed.CONCLUSIONS. Many older colorectal cancer survivors in this population-based cohort underwent testing below a minimum frequency specified by clinical practice guidelines, especially with regard to CEA. Further studies should ascertain the reasons for poor compliance and the effect on patient outcome. Cancer 2008;113:2029-37. (C) 2008 American Cancer Society.