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Jeon J, Lee DB, Shin SJ, Han DH, Chang JS, Han YD, Kim H, Lim JS, Kim HS, Ahn JB. Effect of High-Versus Low-Frequency of Abdominopelvic Computed Tomography Follow-Up Testing on Overall Survival in Patients With Stage II Or III Colon Cancer. Clin Colorectal Cancer 2023; 22:307-317. [PMID: 37271592 DOI: 10.1016/j.clcc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Intensive surveillance of colon cancer by using the abdominopelvic computed tomography (AP-CT) is common in real world practice; however, it is still unclear whether high-frequency surveillance using AP-CT in patients with these risk factors is superior to that in the low-frequency surveillance. PATIENTS AND METHODS We retrospectively reviewed 1803 patients with stage II-III colon cancer receiving curative surgery between January 1, 2005 to December 31, 2015. We evaluated the average scan-to-scan intervals of postoperative AP-CT testing and assigned patients with an interval of 5 to 8 and 9 to 13 months to the high-frequency (HF) and low-frequency (LF) groups, respectively. The cutoff value of preoperative and postoperative CEA levels was 5 ng/mL. We also applied propensity score matching (PSM) and inverse probability of treatment weighting to adjust clinicopathologic differences between the 2 groups. RESULTS We matched 1:1 for each surveillance group yielding a cohort of 776 matched patients. After PSM, Baseline demographics were overall well balanced between 2 groups. Stage III (OR, 2.00; 95% Confidence interval [CI], 1.21-3.30) and postoperative CEA elevation (OR, 2.30; 95% CI, 1.08-4.92) were independent risk factors of recurrence in multivariate analyses. Patient in the HF group had more surgery plus chemo- or radiotherapy as postrecurrence treatment than patient in the LF group (46.2% vs. 23.1%, P = .017). This trend was retained after PSM, although it is not significant (44.4% vs. 23.1%, P = .060). However, survival outcomes of high-frequency AP-CT surveillance were not superior to those of low-frequency surveillance in all subgroups, including stage III (HR 0.99, 95% CI 0.40-2.47) and postoperative CEA elevation (HR 1.36, 95% CI 0.45-4.11). CONCLUSION High-frequency AP-CT testing is associated with a higher proportion of surgery plus chemo- or radiotherapy as postrecurrence treatment, without improvement in 5-year overall survival.
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Affiliation(s)
| | - Da Bin Lee
- Yonsei University College of Medicine, Seoul, Korea
| | - Sang Joon Shin
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dai Hoon Han
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Dae Han
- Department of Colorectal Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunwook Kim
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seok Lim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Han Sang Kim
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea; Graduate School of Medical Science, Brain Korea 21 FOUR Project, Yonsei University College of Medicine, Seoul, Korea.
| | - Joong Bae Ahn
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Chehelgerdi M, Chehelgerdi M. The use of RNA-based treatments in the field of cancer immunotherapy. Mol Cancer 2023; 22:106. [PMID: 37420174 PMCID: PMC10401791 DOI: 10.1186/s12943-023-01807-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 07/09/2023] Open
Abstract
Over the past several decades, mRNA vaccines have evolved from a theoretical concept to a clinical reality. These vaccines offer several advantages over traditional vaccine techniques, including their high potency, rapid development, low-cost manufacturing, and safe administration. However, until recently, concerns over the instability and inefficient distribution of mRNA in vivo have limited their utility. Fortunately, recent technological advancements have mostly resolved these concerns, resulting in the development of numerous mRNA vaccination platforms for infectious diseases and various types of cancer. These platforms have shown promising outcomes in both animal models and humans. This study highlights the potential of mRNA vaccines as a promising alternative approach to conventional vaccine techniques and cancer treatment. This review article aims to provide a thorough and detailed examination of mRNA vaccines, including their mechanisms of action and potential applications in cancer immunotherapy. Additionally, the article will analyze the current state of mRNA vaccine technology and highlight future directions for the development and implementation of this promising vaccine platform as a mainstream therapeutic option. The review will also discuss potential challenges and limitations of mRNA vaccines, such as their stability and in vivo distribution, and suggest ways to overcome these issues. By providing a comprehensive overview and critical analysis of mRNA vaccines, this review aims to contribute to the advancement of this innovative approach to cancer treatment.
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Affiliation(s)
- Mohammad Chehelgerdi
- Novin Genome (NG) Lab, Research and Development Center for Biotechnology, Shahrekord, Iran.
- Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran.
| | - Matin Chehelgerdi
- Novin Genome (NG) Lab, Research and Development Center for Biotechnology, Shahrekord, Iran
- Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
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High Yield of Chest X-ray in the Follow-Up of Colorectal Cancer. J Clin Med 2022; 11:jcm11133828. [PMID: 35807111 PMCID: PMC9267521 DOI: 10.3390/jcm11133828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/02/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose: Worldwide, colorectal carcinoma (CRC) has a high incidence and a substantial cancer-related mortality. The recurrence risk is 30–50% and lung metastases are common. Treatment of lung metastases with stereotactic ablative radiotherapy (SABR) or metastasectomy may increase survival. The best modality for thoracic screening in the follow-up, however, remains controversial. In this study, we aimed to unravel the additional value of routine chest X-ray (CXR) for detecting lung metastases during the follow-up of CRC patients treated with curative surgery. Methods: Between 2013 and 2017, 668 CRC patients were treated with curative intent, of whom 633 patients were included in follow-up, which consisted of CXR, serum Carcino-Embryonic Antigen (CEA) and ultrasound of the liver. Patients who developed lung metastases, diagnosed with CXR and characterised by a normal concomitant serum CEA level, were identified. Number, size and treatment of lung metastases were described. Results: Thirty-four (5.4%) patients developed lung metastases. Seventeen (50%) were detected by CXR without pathological CEA levels. Eleven (65%) of these patients were treated with curative intent, whereas 21% of patients with lung metastases and elevated CEA levels were treated with curative intent (p = 0.049). Higher numbers of lung metastases were associated with a lower chance of curative treatment. Conclusions: More than 50% of patients with lung metastases on CXR in the follow-up would not have been detected with CEA-triggered imaging only. In addition, patients with colorectal lung metastases without elevated CEA levels were often suitable for curative treatment and, therefore, CXR seems to have additional value within the follow-up of CRC.
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Bertoglio P, Ventura L, Aprile V, Cattoni MA, Nachira D, Lococo F, Rodriguez Perez M, Guerrera F, Minervini F, Gnetti L, Lenzini A, Franzi F, Querzoli G, Rindi G, Bellafiore S, Femia F, Bogina GS, Bacchin D, Kestenholz P, Ruffini E, Paci M, Margaritora S, Imperatori AS, Lucchi M, Ampollini L, Terzi AC. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6533422. [PMID: 35188192 PMCID: PMC9252107 DOI: 10.1093/icvts/ivac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/08/2021] [Accepted: 12/17/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
- Corresponding author. Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Largo Nigrisoli 1, Bologna 40133, Italy. Tel: +39-516478362; e-mail: (P. Bertoglio)
| | - Luigi Ventura
- Division of Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | | | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico “A. Gemelli”-Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Lococo
- Department of General Thoracic Surgery, Fondazione Policlinico “A. Gemelli”-Catholic University of Sacred Heart, Rome, Italy
| | | | | | - Fabrizio Minervini
- Division of Thoracic Surgery. Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Letizia Gnetti
- Division of Pathological Anatomy, University Hospital of Parma, Parma, Italy
| | | | - Francesca Franzi
- Division of Pathological Anatomy, University of Insubria, Varese, Italy
| | - Giulia Querzoli
- Division of Pathological Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Guido Rindi
- Division of Pathological Anatomy, Fondazione Policlinico “A. Gemelli”-Catholic University of Sacred Heart, Rome, Italy
| | - Salvatore Bellafiore
- Division of Pathological Anatomy, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Federico Femia
- Division of Thoracic Surgery, University of Torino, Torino, Italy
| | | | - Diana Bacchin
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Peter Kestenholz
- Division of Thoracic Surgery. Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Enrico Ruffini
- Division of Thoracic Surgery, University of Torino, Torino, Italy
| | - Massimiliano Paci
- Division of Thoracic Surgery, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico “A. Gemelli”-Catholic University of Sacred Heart, Rome, Italy
| | | | - Marco Lucchi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Luca Ampollini
- Division of Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Alberto Claudio Terzi
- Division of Thoracic Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
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Bordet M, Bretagne JF, Piette C, Rousseau C, Grainville T, Cosson M, Lièvre A. Surgical rather than endoscopic resection of early-stage colorectal cancers promotes excessive imaging surveillance. Clin Res Hepatol Gastroenterol 2021; 45:101735. [PMID: 34146722 DOI: 10.1016/j.clinre.2021.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Imaging surveillance after curative resection of colorectal cancer (CRC) is debated, particularly in cases of early-stage CRC. The aim of this study was to retrospectively analyze whether and how patients with screened stage 0 and stage 1 CRC were monitored by imaging. METHODS A cohort of patients with stage 0 (intramucosal) or stage 1 (T1N0) CRC detected from 2003 to 2015 through the French national screening programme was included. All imaging findings were recorded. Statistical analyses were performed for the entire cohort (n = 450) and separately for the two groups (stage 0 n = 268, stage 1 n = 182). Factors associated with imaging surveillance, including the patient's referring gastroenterologist, were determined by logistic regression. RESULTS A total of 450 patients were followed up for 6.6 ± 3.9 years. Imaging surveillance was performed for 159 (35.3%), more often for those with stage 1 (66.5%) than stage 0 (14.2%) tumours (p < 0.0001). Within the stage 1 group, 17 of the 47 patients (36.2%) treated by local (endoscopic or surgical transanal) resection alone were followed up by imaging monitoring. Factors significantly associated with surveillance in the entire cohort were the gastroenterologist assigned to the patient (p < 0.0001) and surgical vs endoscopic resection (OR = 39.0, p < 0.0001). The histological risk of lymph node metastasis was not significantly associated with imaging monitoring for stage 1 patients. Of the 5 patients who developed distant metastasis during follow-up, one was diagnosed through imaging surveillance. CONCLUSION This study demonstrates excessive imaging surveillance for early-stage cancers. The use of surgical over endoscopic tumour resection could promote unnecessary surveillance.
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Affiliation(s)
- Martin Bordet
- Department of Gastroenterology, University Hospital, 35033 Rennes, France
| | | | - Christine Piette
- ADECI 35 (Association pour le Dépistage des Cancers en Ille-et-Vilaine), 35040 Rennes, France
| | - Chloé Rousseau
- Department of Biostatistics, University Hospital, 35033 Rennes, France
| | - Thomas Grainville
- Department of Gastroenterology, University Hospital, 35033 Rennes, France
| | - Mathilde Cosson
- ADECI 35 (Association pour le Dépistage des Cancers en Ille-et-Vilaine), 35040 Rennes, France
| | - Astrid Lièvre
- Department of Gastroenterology, University Hospital, 35033 Rennes, France; Rennes 1 University, 35000 Rennes, France; ADECI 35 (Association pour le Dépistage des Cancers en Ille-et-Vilaine), 35040 Rennes, France; COSS (Chemistry Oncogenesis Stress Signaling), UMR_S 1242, Rennes, France
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Qaderi SM, Ezendam NP, Verhoeven RH, Custers JA, de Wilt JH, Mols F. Follow-up practice and healthcare utilisation of colorectal cancer survivors. Eur J Cancer Care (Engl) 2021; 30:e13472. [PMID: 34081367 PMCID: PMC8518769 DOI: 10.1111/ecc.13472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine healthcare utilisation and adherence to colorectal cancer (CRC) follow-up guidelines. METHODS A total of 2450 out of 3025 stage I-III CRC survivors diagnosed between 2000 and 2009 completed the Hospital Anxiety and Depression Scale, SF-12, EORTC QLQ-CR38 and Fatigue Assessment Score questionnaires, in December 2010. Multivariable regression analyses were performed to identify predictors for increased follow-up care (>1 visit than recommended by guidelines). RESULTS In the first follow-up year, the average number of cancer-related visits to the general practitioner and medical specialist was 1.7 and 4.2, respectively. More than 80% of the CRC survivors was comfortable with their follow-up schedule, and 49-72% of them received follow-up according to the guidelines. Around 29-47% was followed more than recommended. Simultaneously, around 4-14% of the CRC survivors received less follow-up care than recommended. Survivors of stage III disease treated with chemotherapy received the most follow-up care. In addition, lower socio-economic status stoma and fatigue were associated with increased follow-up care. CONCLUSION CRC survivors were predominantly followed according to national guidelines. Increased follow-up care is driven by advanced disease stage, chemotherapy, SES, stoma and fatigue. Future studies should investigate how increased follow-up care use can be reduced, while still addressing patients' needs.
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Affiliation(s)
- Seyed M. Qaderi
- Department of Surgical OncologyRadboud university medical centerNijmegenThe Netherlands
| | - Nicole P.M. Ezendam
- Department of Research & DevelopmentNetherlands Comprehensive Cancer OrganisationUtrechtthe Netherlands
- Department of Medical and Clinical PsychologyCoRPS‐Center of Research on Psychological and Somatic disordersTilburg UniversityTilburgThe Netherlands
| | - Rob H.A. Verhoeven
- Department of Surgical OncologyRadboud university medical centerNijmegenThe Netherlands
- Department of Research & DevelopmentNetherlands Comprehensive Cancer OrganisationUtrechtthe Netherlands
| | - Jose A.E. Custers
- Department of Medical PsychologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Johannes H.W. de Wilt
- Department of Surgical OncologyRadboud university medical centerNijmegenThe Netherlands
| | - Floortje Mols
- Department of Research & DevelopmentNetherlands Comprehensive Cancer OrganisationUtrechtthe Netherlands
- Department of Medical and Clinical PsychologyCoRPS‐Center of Research on Psychological and Somatic disordersTilburg UniversityTilburgThe Netherlands
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Qaderi SM, Andersson TML, Dickman PW, de Wilt JHW, Verhoeven RHA. Temporal improvements noted in life expectancy of patients with colorectal cancer; a Dutch population-based study. J Clin Epidemiol 2021; 137:92-103. [PMID: 33836257 DOI: 10.1016/j.jclinepi.2021.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Specific survival estimates are needed for the increasing number of colorectal cancer (CRC) survivors. The aim of this population-based study was to determine conditional loss in expectation of life (LEL) due to CRC. STUDY DESIGN AND SETTING All surgically treated patients with CRC registered in the Netherlands Cancer Registry with stage I-III between 1990-2016, were included (N = 203,216). Estimates of conditional LEL were predicted using flexible parametric models and the total life years lost due to cancer were estimated. RESULTS LEL decreased with older age and patients with rectal cancer or higher disease stage had highest LEL. In 2010, LEL for sixty-year old male and female patients was 2 vs. 2, 4 vs. 4, and 7 vs. 8 years for colon cancer, and 2 vs. 2, 4 vs. 5 and 7 vs. 8 years for rectal cancer, respectively. Conditional LEL in patients with CRC decreased during follow-up. Patients with combined stage I-III colon and rectal cancer in 2010 lost an estimated 18,628 and 11,336 life years. CONCLUSION This study quantified the impact of CRC on patient's life expectancy, both on individual and population level and demonstrated temporal improvements in CRC survival. These results provide meaningful information that can be used during follow-up.
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Affiliation(s)
- Seyed M Qaderi
- Department of Surgical Oncology, Radboud university medical center, Nijmegen, The Netherlands.
| | - Therese M L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johannes H W de Wilt
- Department of Surgical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Rob H A Verhoeven
- Department of Surgical Oncology, Radboud university medical center, Nijmegen, The Netherlands; Department of Research and Development, Comprehensive Netherlands Cancer Organization, Utrecht, The Netherlands
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Caycedo-Marulanda A, Patel SV, Verschoor CP, Uscategui JP, Chadi SA, Moeslein G, Chand M, Maeda Y, Monson JRT, Wexner SD, Mayol J. A Snapshot of the International Views of the Treatment of Rectal Cancer Patients, a Multi-regional Survey: International Tendencies in Rectal Cancer. World J Surg 2020; 45:302-312. [PMID: 33033856 DOI: 10.1007/s00268-020-05795-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Management of rectal cancer has a number of potentially appropriate alternatives for each patient. Despite acceptance of standards, practices may vary among regions. There is significant paucity of data in this area. The objective was to create a snapshot of the regional differences. DESIGN This online survey included 10 questions. Enquiries focused on controversial topics, on surgeon and hospital volume, surgical margins, appropriateness of surgical approaches and techniques, watch-and-wait strategies, and total neoadjuvant therapy. Major colorectal surgery societies around the world were asked to invite their members to complete the survey. OUTCOME MEASURES Frequency of responses across regions within each question was compared by Fisher's exact test. RESULTS Seven hundred and fifty-three participants from 60 countries responded. Eight regions were identified, and four had sufficient representation for comparisons. Similarities and differences in the therapies among these regions were identified. Robotic surgery penetrance is higher in North America, and watch and wait is more accepted in South America. Patients in Oceania are more likely to be diverted; Europe has more usage of taTME. DISCUSSION This online survey was practical as a mean to provide a rapid assessment of the international picture on consistency and variability of rectal cancer patients' care, and to potentially identify opportunities to standardized care to patients. Medical surveys have inherent limitations; pertinence to our study is selection bias. CONCLUSIONS The management of rectal cancer varies among different regions. Identification of differences is important when considering global efforts to improve management and interpret data.
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Affiliation(s)
- Antonio Caycedo-Marulanda
- Department of Surgery, Queens University, Kingston, Canada. .,Health Sciences North Research Institute, Sudbury, Canada. .,Kingston General Hospital, Kingston, Canada.
| | - Sunil V Patel
- Department of Surgery, Queens University, Kingston, Canada
| | | | | | - Sami A Chadi
- Department of Surgery University Health Network (UHN), Toronto, Canada
| | - Gabriela Moeslein
- Department of Surgery, University of Witten/Herdecke, Witten, Germany
| | - Manish Chand
- Department of Surgery, University College London, London, UK
| | - Yasuko Maeda
- Department of Colorectal Surgery, Western General Hospital, Edinburgh, Scotland, UK
| | - John R T Monson
- Center for Colon and Rectal Surgery, Digestive Health and Surgery Institute, AdventHealth Orlando, Orlando, USA
| | - Steven D Wexner
- Department of Surgery, Cleveland Clinic Florida, Weston, USA
| | - Julio Mayol
- Department of Surgery, Hospital Clinico San Carlos, Madrid, Spain
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Qaderi SM, Swartjes H, Custers JAE, de Wilt JHW. Health care provider and patient preparedness for alternative colorectal cancer follow-up; a review. Eur J Surg Oncol 2020; 46:1779-1788. [PMID: 32571636 DOI: 10.1016/j.ejso.2020.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/06/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Follow-up after curative treatment for colorectal cancer (CRC) puts pressure on outpatient services due to the growing number of CRC survivors. The aim of this state-of-the-art review was to evaluate setting, manner and provider of follow-up. Moreover, perceptions of CRC survivors and health care providers regarding standard and alternative follow-up were examined. After a comprehensive literature search of the PubMed database, 69 articles were included reporting on CRC follow-up in the hospital, primary care and home setting. Hospital-based follow-up is most common and has been provided by surgeons, medical oncologists, and gastroenterologists, as well as nurses. Primary care-based follow-up has been provided by general practitioners or nurses. Even though most hospital- or primary care-based follow-up care requires patients to visit the clinic, telephone-based care has proven to be a feasible alternative. Most patients perceived follow-up as positive; valuing screening and detection for disease recurrence and appreciating support for physical and psychosocial symptoms. Hospital-based follow-up performed by the medical specialist or nurse is highly preferred by patients and health care providers. However, willingness of both patients and health care providers for alternative, primary care or remote follow-up exists. Nurse-led and GP-led follow-up have proven to be cost-effective alternatives compared to specialist-led follow-up. If proven safe and acceptable, remote follow-up can become a cost-effective alternative. To decrease the personal and financial burden of follow-up for a growing number of colorectal cancer survivors, a more acceptable, flexible and dynamic care follow-up mode consisting of enhanced communication and role definitions among clinicians is warranted.
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Affiliation(s)
- S M Qaderi
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - H Swartjes
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J A E Custers
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J H W de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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