Follow-Up Adherence After Treatment With Curative Intent for Stage II and III Colorectal Cancer Patients

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2025-02-27 DOI:10.1002/cam4.70667

Tara C. Boute, Rik van Eekelen, Marloes A. G. Elferink, Lissenberg Witte Birgit I, Johannes H. W. de Wilt, Geraldine R. Vink, Marjolein J. E. Greuter, Veerle M. H. Coupé

{"title":"Follow-Up Adherence After Treatment With Curative Intent for Stage II and III Colorectal Cancer Patients","authors":"Tara C. Boute, Rik van Eekelen, Marloes A. G. Elferink, Lissenberg Witte Birgit I, Johannes H. W. de Wilt, Geraldine R. Vink, Marjolein J. E. Greuter, Veerle M. H. Coupé","doi":"10.1002/cam4.70667","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>After colorectal cancer (CRC) treatment, patients undergo five-year follow-up involving carcinoembryonic antigen (CEA) tests, imaging, and colonoscopies. This retrospective cohort study explores adherence to the CRC follow-up guideline in the Netherlands until 2021 and its association with treatment of recurrences with curative intent.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Stage II/III CRC patients with recurrent disease within 3 years after diagnosis were selected from the Netherlands Cancer Registry (<i>n</i> = 430). Adherence to CEA tests, imaging, and colonoscopy was classified as ‘according to/more follow-up’ or ‘less follow-up’ than recommended. Logistic regression analyses examined factors associated with receiving less follow-up and the relationship between ‘follow-up adherence’ and ‘treatment with curative intent’, potentially mediated by ‘mode of detection’ (symptomatically vs. routine test).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>In total, 18.3% patients had fewer CEA tests, 41.4% fewer imaging, and 56.1% fewer colonoscopies than recommended. Factors associated with fewer follow-up moments were tumor localization, age (≥ 75 years), comorbidities, tumor differentiation and adjuvant chemotherapy. Patients receiving fewer CEA tests faced 4.8 times higher odds (95% CI: 2.9–8.1) of symptom-detected recurrence and were less likely to be curatively treated (OR = 0.5; 95% CI: 0.3–0.9). Mediation analysis indicated a significant average causal mediation effect (<i>p</i> = 0.003), emphasizing the mediating role of mode of detection. Receiving fewer imaging and colonoscopies showed insignificant total effects on treatment with curative intent.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Our findings offer insights into follow-up adherence, detection mode, and treatment with curative intent. The discovery that adherence was highest for CEA, along with the correlation between CEA adherence and treatment with curative intent, aligns with the recent adaptation of guidelines emphasizing CEA measurement over imaging.</p>\n </section>\n </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 5","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70667","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cam4.70667","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

After colorectal cancer (CRC) treatment, patients undergo five-year follow-up involving carcinoembryonic antigen (CEA) tests, imaging, and colonoscopies. This retrospective cohort study explores adherence to the CRC follow-up guideline in the Netherlands until 2021 and its association with treatment of recurrences with curative intent.

Methods

Stage II/III CRC patients with recurrent disease within 3 years after diagnosis were selected from the Netherlands Cancer Registry (n = 430). Adherence to CEA tests, imaging, and colonoscopy was classified as ‘according to/more follow-up’ or ‘less follow-up’ than recommended. Logistic regression analyses examined factors associated with receiving less follow-up and the relationship between ‘follow-up adherence’ and ‘treatment with curative intent’, potentially mediated by ‘mode of detection’ (symptomatically vs. routine test).

Results

In total, 18.3% patients had fewer CEA tests, 41.4% fewer imaging, and 56.1% fewer colonoscopies than recommended. Factors associated with fewer follow-up moments were tumor localization, age (≥ 75 years), comorbidities, tumor differentiation and adjuvant chemotherapy. Patients receiving fewer CEA tests faced 4.8 times higher odds (95% CI: 2.9–8.1) of symptom-detected recurrence and were less likely to be curatively treated (OR = 0.5; 95% CI: 0.3–0.9). Mediation analysis indicated a significant average causal mediation effect (p = 0.003), emphasizing the mediating role of mode of detection. Receiving fewer imaging and colonoscopies showed insignificant total effects on treatment with curative intent.

Conclusion

Our findings offer insights into follow-up adherence, detection mode, and treatment with curative intent. The discovery that adherence was highest for CEA, along with the correlation between CEA adherence and treatment with curative intent, aligns with the recent adaptation of guidelines emphasizing CEA measurement over imaging.

Abstract Image

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.