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Receipt of recommended surveillance among colorectal cancer survivors: a systematic review

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Abstract

Purpose

Regular surveillance decreases the risk of recurrent cancer in colorectal cancer (CRC) survivors. However, studies suggest that receipt of follow-up tests is not consistent with guidelines. This systematic review aimed to: (1) examine receipt of recommended post-treatment surveillance tests and procedures among CRC survivors, including adherence to established guidelines, and (2) identify correlates of CRC surveillance.

Methods

Systematic searches of Medline, PubMed, PsycINFO, CINAHL Plus, and Scopus databases were conducted using terms adapted for each database’s keywords and subject headings. Studies were screened for inclusion using a three-step process: (1) lead author reviewed abstracts of all eligible studies; (2) coauthors reviewed random 5 % samples of abstracts; and (3) two sets of coauthors reviewed all “maybe” abstracts. Discrepancies were adjudicated through discussion.

Results

Thirty-four studies are included in the review. Overall adherence ranged from 12 to 87 %. Within the initial 12 to 18 months post-treatment, adherence to recommended office visits was 93 %. Adherence ranged from 78 to 98 % for physical exams, 18–61 % for colonoscopy, and 17–71 % for carcinoembryonic antigen (CEA) testing. By 2 to 3 years post-treatment, cumulative adherence ranged from 70 to 88 % for office visits, 89–93 % for physical exams, 49–94 % for colonoscopy, and 7–79 % for CEA testing. Between 18 and 28 % of CRC survivors received greater than recommended overall surveillance; overuse of physical exams (42 %), colonoscopy (24–76 %), and metastatic disease testing (1–29 %) was also prevalent. Studies of correlates of CRC surveillance focused on sociodemographic and disease/treatment characteristics, and patterns of association were inconsistent across studies.

Conclusions

Deviation from surveillance recommendations includes both under- and overuse. Examination of modifiable determinants is needed to inform interventions targeting appropriate and timely receipt of recommended surveillance.

Implications for Cancer Survivors

Among CRC survivors, it remains unclear what modifiable psychosocial factors are associated with the observed under- and overuse of surveillance. Understanding and intervening with these psychosocial factors is critical to improving adherence to guideline-recommended surveillance and thereby reducing mortality among this group of survivors.

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Acknowledgments

The authors would like to thank Helena Vonville, MLS for her assistance in developing the search strategy. This work was supported by the National Cancer Institute at the National Institutes of Health (K07CA140159 to M.Y.C. and R01CA112223 to S.W.V.) and the Susan G. Komen Foundation (KG111378 to S.M.B.). S.M.B. was also supported by the Cancer Education and Career Development Program at the School of Public Health, University of Texas Health Science Center at Houston, funded by the National Cancer Institute (R25T 2R25CA57712). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, or the Susan G. Komen Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Center for Health Promotion and Prevention Research, The University of Texas School of Public Health, 7000 Fannin Street, Suite 2516, Houston, TX, 77030, USA

    Melissa Y. Carpentier, Sally W. Vernon, L. Kay Bartholomew, Caitlin C. Murphy & Shirley M. Bluethmann

Authors
  1. Melissa Y. Carpentier
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  2. Sally W. Vernon
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  3. L. Kay Bartholomew
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  4. Caitlin C. Murphy
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Corresponding author

Correspondence to Melissa Y. Carpentier.

Appendix

Appendix

Search strategy for Ovid Medline

  1. 1.

    exp Colorectal neoplasms/

  2. 2.

    (crc or ((colorectal or colon or rectal) adj3 (cancer* or neoplasm* or polyp*))).ti,ab.

  3. 3.

    1 or 2

  4. 4.

    Survivors/ or survivor*.ti,ab.

  5. 5.

    3 and 4

  6. 6.

    Mass screening/

  7. 7.

    screen*.ti,ab.

  8. 8.

    surveillance.ti,ab. or follow-up.ti,ab.

  9. 9.

    exp Colonoscopy/

  10. 10.

    exp Sigmoidoscopy/

  11. 11.

    exp Endoscopy/

  12. 12.

    Barium enema.ti,ab.

  13. 13.

    Occult blood/

  14. 14.

    or/6–13

  15. 15.

    5 and 14

  16. 16.

    Limit 15 to English language

Search strategy for PubMed

  1. 1.

    Colorectal neoplasms[mesh0]

  2. 2.

    (crc[tiab] OR colorectal[tiab] OR colon[tiab] OR rectal[tiab] AND (cancer*[tiab] OR neoplasm*[tiab] OR polyp*[tiab])

  3. 3.

    #1 OR #2

  4. 4.

    Survivors[mesh:noexp] OR survivor*[tiab]

  5. 5.

    #3 AND #4

  6. 6.

    Mass screening[mesh:noexp]

  7. 7.

    Screen*[tiab]

  8. 8.

    Surveillance[tiab] OR follow-up[tiab]

  9. 9.

    Colonoscopy[mesh]

  10. 10.

    Sigmoidoscopy[mesh]

  11. 11.

    Endoscopy[mesh]

  12. 12.

    Barium enema[tiab]

  13. 13.

    Occult blood[mesh:noexp]

  14. 14.

    #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13

  15. 15.

    #5 AND #14

  16. 16.

    #5 AND #14 Filters: English

Search strategy for Ovid PsycINFO

  1. 1.

    Colorectal neoplasms/

  2. 2.

    ((crc or colorectal or colon or rectal) adj4 (cancer* or neoplasm* or polyp*)).ti,ab,id.

  3. 3.

    1 or 2

  4. 4.

    Survivors/ or survivor*.ti,ab,id.

  5. 5.

    3 and 4

  6. 6.

    Mass screening.md.

  7. 7.

    Screen*.ti,ab,id.

  8. 8.

    Surveillance.ti,ab,id. or follow-up.ti,ab,id.

  9. 9.

    Colonoscopy/

  10. 10.

    Sigmoidoscopy/

  11. 11.

    Endoscopy/

  12. 12.

    Barium enema.ti,ab,id.

  13. 13.

    Occult blood/

  14. 14.

    or/6–13

  15. 15.

    5 and 14

  16. 16.

    Limit 15 to English language

Search strategy for CINAHL

  1. 1.

    (MH “Colorectal Neoplasms”)

  2. 2.

    TI ( (crc or colorectal or colon or rectal) and (cancer* or neoplasm* or polyp*) ) or AB ( (crc or colorectal or colon or rectal) and (cancer* or neoplasm* or polyp*) )

  3. 3.

    S1 or S2

  4. 4.

    (MH “Survivors”)

  5. 5.

    TI survivor* or AB survivor*

  6. 6.

    S4 or S5

  7. 7.

    S3 and S6

  8. 8.

    Mass screening/

  9. 9.

    TI screen* or AB screen*

  10. 10.

    TI (surveillance or follow-up) or AB (surveillance or follow-up)

  11. 11.

    (MH “Colonoscopy”)

  12. 12.

    (MH “Sigmoidoscopy”)

  13. 13.

    (MH “Endoscopy”)

  14. 14.

    TI barium enema or AB barium enema

  15. 15.

    Occult blood/

  16. 16.

    S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15

  17. 17.

    S7 and S16

  18. 18.

    S7 and S16 limiters—English language

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Carpentier, M.Y., Vernon, S.W., Bartholomew, L.K. et al. Receipt of recommended surveillance among colorectal cancer survivors: a systematic review. J Cancer Surviv 7, 464–483 (2013). https://doi.org/10.1007/s11764-013-0290-x

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  • DOI: https://doi.org/10.1007/s11764-013-0290-x

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