Boute TC, van Eekelen R, Elferink MAG, Birgit LW, de Wilt JHW, Vink GR, Greuter MJE, Coupé VMH. Follow-Up Adherence After Treatment With Curative Intent for Stage II and III Colorectal Cancer Patients.
Cancer Med 2025;
14:e70667. [PMID:
40013322 PMCID:
PMC11865713 DOI:
10.1002/cam4.70667]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 11/15/2024] [Accepted: 01/29/2025] [Indexed: 02/28/2025] Open
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.
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