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Additional evidence of no increased survival benefit to intensive follow-up after colorectal cancer surgery
Clinical Question
Does intensive follow-up after curative surgery for colorectal cancer reduce morbidity and mortality?
Bottom line
This study found similar results to 2 other studies in the same journal (see Synopsis): Intensive follow-up after curative surgery for colorectal cancer does not reduce cancer-specific or all-cause mortality. An individual's risk of undergoing repeat surgery with associated morbidity and mortality is likely increased with high-frequency versus low-frequency follow-up testing. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Foundation
Setting: Inpatient (any location) with outpatient follow-up
Synopsis
A previous study in this same journal reported that intensive follow-up compared with minimal follow-up after curative surgery for colorectal cancer resulted in more patients undergoing repeat surgery but no reduction in overall mortality or disease-specific mortality (Primrose JN, et al. JAMA 2014;311(3):263-70). In a similar study, these investigators enrolled adults, 75 years or younger, after surgical resection with curative intent with stage II or III colorectal cancer. After either a normal CEA test or negative diagnostic work-up 1 month after surgery, 2555 patients randomly received assignment (concealed allocation) to a high-frequency follow-up group (computed tomography [CT] scan of thorax and abdomen and carcinoembryonic antigen [CEA] testing at 6, 12, 18, 24, and 36 months after surgery) or a low-frequency follow-up group (CT scan of thorax and abdomen and CEA testing at 12 and 36 months after surgery). Complete follow-up occurred for 99.9% of patients at 5 years. Using both intention-to-treat and per-protocol analysis, there were no significant group differences in all-cause or cancer-specific mortality rates. There were also no group differences in outcomes according to cancer stage or location (including both colon and rectal sites). A third study in the same journal issue (Snyder RA, et al. JAMA 2018;319(20):2104-15) also found no significant association between intensity of follow-up and detection of recurrence or overall survival.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Very helpful BUT will the oncologists follow the evidence ??
good poem
something to think about !
Interesting, and confirms what I thought from experience.
Wow; quite sad to learn that such studies are finding no significant association between intensity of follow-up and detection of recurrence or overall survival for colon cancer patients. Seems to suggest that CEA testing may not really be worth it.