Attitudes towards and schedule of surveillance after curative treatment for colorectal and breast cancer in regional hospital in queensland

Abstract

Background/Aims: Despite multimodality treatment a number of patients treated for early breast or colorectal cancer will relapse. Based on available evidence ASCO, ESMO and NHMRC created guidelines for follow up of those patients. The aim of the project was to investigate attitudes towards surveillance as well as compare practice to set guidelines. To my knowledge, there was only one survey trying to answer such question (exploring attitudes to colorectal cancer follow up amongst Australian medical oncologists).Methods: A survey was distributed amongst specialists attending breast and gastrointestinal multidisciplinary team meetings. The survey was in paper form and was returned on completion (18 responses out of 21 possible).Results: Over 60% of responders found the follow up to be benefi cial both psychologically for the patient and in terms of disease control. The surgeon and General Practitioner were deemed necessary in surveillance process; interestingly the oncologist was thought to be so by just over the half of the responders. As to the attitudes towards formal guidelines, almost 45% of specialists reported adherence to one in colorectal cancer follow-up cf. 10% in breast cancer. Contrary to the statements, the use of investigations in breast cancer surveillance was very similar to recommendations; in colorectal cancer on the other hand, the use of CT scanning was reported by 2/3 of responders only. However, the frequency of outpatient visits in CRC surveillance was more consistent with guidelines (100-78% depending on the year of follow up). The breast cancer patient follow up frequency was less consistent with poorest adherence in year 3 (55% reporting annual visits) and after year 5 (no follow-up visits in 78%). Finally, 44% of responders thought MDT should be making recommendations on most appropriate follow-up.Conclusion: Taking into account the fact that most responders denied adherence to any guidelines in the care of breast and colorectal cancer survivors, the schedule and content of surveillance quite closely resembled the recommended ones. The main areas of discrepancy were underutilization of imaging in colorectal cancer and less frequent follow-up visits in breast cancer surveillance.<br />