GEOGRAPHIC-VARIATION IN PATIENT SURVEILLANCE AFTER COLON-CANCER SURGERY

Purpose: Considerable variation among surgeons exists in the current p ractice of patient surveillance after colon cancer treatment. We evalu ated whether geographic factors are responsible for this observed vari ation. Methods: Profiles of hypothetical patients and a detailed quest ionnaire based on the profiles were mailed to 2,733 members of two nat ional surgical societies. The influence of the geographic location of the respondents on practice patterns was assessed in two ways. Repeate d-measures analysis of variance was used to compare the practice patte rns among 19 large metropolitan statistical areas (MSAs) and chi(2) an alysis was used to determine whether these patterns differed by MSA po pulation size. Results: Seven of nine commonly used surveillance modal ities were ordered significantly more frequently with increasing tumor -node-metastasis (TNM) stage and significantly less frequently with ye ar postsurgery among the 995 respondents with assessable responses, bu t MSA population size and geographic location of physicians generally had no effect on documented practice variability. The remaining two mo dalities (bone scan and computed tomography [CT]) were used so infrequ ently as to preclude meaningful analysis. Conclusion: Surveillance aft er potentially curative colon cancer surgery for otherwise healthy pat ients is not significantly affected by the geographic location of the surgeon who performs the surveillance testing and only modestly affect ed by the population size of the MSA in which he/she practices. These data should help in the design of prospective trials of this topic. (C ) 1996 by American Society of Clinical Oncology.