Patterns of endoscopic follow-up after surgery for nonmetastatic colorectal cancer

Background: Endoscopic examinations of the colon are often recommended for surveillance following colorectal cancer resection. The actual use and outc ome of this testing are not known. Methods: Five thousand seven hundred sixteen patients 65 years of age or ol der with local or regional stage colorectal cancer diagnosed in 1991 were i dentified through the Surveillance Epidemiology and End Results registry. A ll inpatient and outpatient Medicare claims from 6 months after diagnosis t hrough the end of 1994 were examined to determine use of endoscopic procedu res. Results: One or more colonoscopies were performed in 51%, with an average o f 2.9 procedures performed among those tested; sigmoidoscopy was performed in 17%. The rate of colonoscopy was highest during the initial 18 months. P olypectomy was performed in 21% of all patients, and subsequent primary col orectal tumors were diagnosed in 1.3%. Factors associated with colonoscopy and sigmoidoscopy use included younger age, survival through follow-up, and geographic region; sigmoidoscopy was also more common in relation to recta l cancers. Conclusions: There is variability in the use of endoscopic procedures follo wing potentially curative resection for colorectal cancer, with patient-rel ated factors and local practice patterns accounting for the variation. Furt her studies are needed to elicit the reasons for lack of follow-up and adhe rence to practice guidelines.