SURVEILLANCE AFTER CURATIVE COLON-CANCER RESECTION - PRACTICE PATTERNS OF SURGICAL SUBSPECIALISTS

Background: In the literature, suggested strategies for the follow-up of colon cancer patients after potentially curative resections vary wi dely, The optimal regimen to monitor for recurrences and new primary t umors remains unknown. The nationwide cost impact of wide practice var iation is also unknown. Methods: The 1,070 members of The Society of S urgical Oncology (SSO) were surveyed using a detailed questionnaire to measure the practice patterns of surgical experts nationwide. Respond ents were asked how often they use nine separate methodologies in foll owup during years 1-5 postsurgery for TNM stage I, II, and III patient s. Costs were estimated for representative less and more intensive str ategies. Results: Evaluable responses were received from 349 members ( 33%). Office visit and carcinoembryonic antigen analysis were performe d most frequently. SSO members generally see patients every 3 months i n years 1-2, every 6 months in years 3-4, and annually thereafter. The re was wide variability in test ordering patterns and moderate variati on between SSO and previously surveyed American Society of Colon and R ectal Surgeons members. The charge differential between representative less and more intensive follow-up strategies for each annual U.S. pat ient cohort is similar to$800 million. Conclusions: Actual practice pa tterns vary widely, indicating lack of consensus regarding optimal fol low-up. The enormous cost differential associated with such variation is difficult to justify because there is no proven benefit of more int ensive follow-up.