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. Author manuscript; available in PMC: 2014 Sep 1.
Published in final edited form as: J Cancer Surviv. 2013 May 16;7(3):464–483. doi: 10.1007/s11764-013-0290-x

Table 1.

Receipt of recommended post-treatment surveillance tests and procedures among CRC survivors

Primary author (year) Data source Sample size/ characteristics Eligibility criteria Year(s) of diagnosis Follow-up period Outcome variable(s) Results Operational definition of adherence/basis for definition a
Boehmer (2010) Medical records n = 253; ≤54 to ≥75y; 58% male; 54% White; safety net patients Non-metastatic CRC; treated w/curative intent; no recurrence during study period 2003–2007 5y post-dx % COL 1/3y post-tx 27/56% COL 1 & 3y post-tx
(referenced 2008 ACS, USMTFCC)
Borie (2004) Regional cancer registry along with medical records n = 231; mean age 64y (standard group) to 69y (minimal group); 56% male; French sample CRC treated with potentially curative surgery; able to be classified into 1 of 2 (standard vs. minimal) follow-up groups 1992 5y post-tx Mean number PE (standard/minimal) 20/7 Standard follow-up: CEA every 4–6m for 3y, then once a year for 2y; PE every 3m for 2y, then every 6m for 3y; 1 COL every 3y; US every 4–6m for 3y, then once a year for 2y; annual CXR
Mean number US (standard/minimal) 6/2
Mean number COL (standard/minimal) 5/2
Mean number CXR (standard/minimal) 4/1 Minimal follow-up: CEA & US once a year for 3y; PE every 6m for 5y; 1 COL every 3y; CXR once a year for 2y
(based on 1998 French Consensus Guidelines)
Mean number CEA (standard/minimal) 12/3
Boulin (2005) Regional cancer registry along with medical records and provider surveys as necessary n = 409; mean age 71y; 55% male; 30% advanced stage CRC; French sample Diagnosed with CRC Stage A, B, or C or Stage D with complete resection of liver metastasis; alive without recurrence ≥ 6m post-curative surgery 1998 3y post-tx % below/within/over standard for clinical exams 35/23/42% Clinical exam every 3m for first 2y; every 6m for next 3y
% below/within/over standard for abdominal US 65/35/1% Abdominal US every 3–6m for first 3y; yearly for next 2y
% below/within/over standard for CXR 52/19/29% CXR yearly for 5y
% below/within/over standard/inappropriate time for COL 20/27/24/29% COL after 3y (or 1y if ≥ 3 adenomas with one > 1 cm diameter or presenting villous component
Optional testing:
% CEA within 3y		 56% Optional: CEA
(based on 1998 French Consensus Guidelines)
Cluster analysis:
% “minimal/moderate/ intensive” surveillance		 47/24/29%
Brawarsky (2013) SEER-Medicare n = 38,889; 56% female; 88/7/5% White/Black/ Hispanic; median age 75y (White), 74y (Black/ Hispanic) 66 to 85y; White, Black, or Hispanic; diagnosed with first CRC; stage I-III; treated with surgery; alive at end of study period 1993–2005 Through Dec 2007 % COL 15m post-tx 61% At least 1 COL 15m post-surgery
% PC visits 2y post-tx 77% At least 2 PC visits 2y post-surgery
% CEA 2y post-tx 68% At least 2 CEA 2y post-surgery (stage II/III)
% overall surveillance 43% Overall surveillance: COL and PC visits for stage I or COL, PC, and CEA for stage II/III
(based on 2012 NCCN)
Cardella (2008) Medical records n = 96; median age 64y; 60% male; median time post-tx 34m; Canadian sample 19 to 75y; curative intent resection of CRC; non-metastatic disease; able to go home and assume active daily living; alive and disease-free through end of study period 2000–2002 Through October 2004 % clinic visits over follow-up period 70% Clinic visits every 6m for first 3y, followed by 12m intervals until 5y post-tx
% CEA over follow-up period 49%
% abdominal imaging over follow-up period 62% CEA, CXR, and abdominal imaging (CT or abdominal US) at each clinic visit
% COL over follow-up period 94% COL 1y post-tx and every 3y thereafter
(basis for adherence definition not reported)
Cheung (2008) Academic and comm cancer center registries along with medical records n = 341 (244 academic, 97 community); overall median age 62y; 58% male; 57% stage III; Canadian sample Stage II or III CRC; referred to either cancer center for follow-up after curative resection; able to be monitored for ≥5y post-dx; not enrolled in clinical trials 1999–2001 5y post-dx Median CV (academic/ community) 11/9 Over the first 5y period of surveillance: 8–14 CV
Median CEA (academic/ community) 9/9 8–30 CEA
1 COL
Median COL (academic/ community) 2/2 Not routinely recommended: CBC, LFT, CXR, chest CT, abdominal CT, pelvic CT
(based on 1999, 2000 ASCO)
% below CV recommendations (academic/community) 23/23%
% above CV recommendations (academic/community) 17/0%
% below CEA recommendations (academic/community) 41/29%
% above CEA recommendations (academic/community) 0/0%
% below COL recommendations (academic/community) 15/3%
% above COL recommendations (academic/community) 67/76%
Non-recommended testing:
% non-recommended CBC/LFT/CXR/chest CT/ abdominal CT/pelvic CT in academic center		 94/91/70/42/9 3/91%
% non-recommended CBC/LFT/CXR/chest CT/abdominal CT/pelvic CT in community center 99/100/37/14/ 38/34%
Cooper (1999) SEER-Medicare n = 5716; mean age 75y; 51% female; 6% African-American Medicare beneficiaries; local or regional CRC; underwent surgical resection; alive 6m post-dx; complete follow-up data 1991 Through 1994 %/mean COL 58%/2.8 NR/NR
%/mean abdominal CT 29%/2.8
%/mean pelvic CT 23%/2.6
%/mean CXR 66%/4.2
%/mean abdominal US 15%/14.8
%/mean liver enzymes 74%/4.7
%/mean CEA 38%/2.3
%/mean overall procedures 87%/12.9
Cooper (2000) SEER-Medicare n = 5716; mean age 75y; 51% female; 6% African-American Medicare beneficiaries; local or regional CRC; underwent surgical resection; alive 6m post-dx; complete follow-up data 1991 Through 1994 % 1 COL/>1 COL 7–12m post-dx 22/14% NR/NR
% 1 COL/>1 COL 13–18m post-dx 23/15%
% 1 COL/>1 COL 19–24m post-dx 15/10%
% 1 COL/>1 COL 25–30m post-dx 16/10%
% 1 COL/>1 COL 31–36m post-dx 12/8%
Cooper (2006) SEER-Medicare n = 62,882; 55% female; 86% White Medicare beneficiaries; ≥65y; treated w/curative intent; alive 1 & 3y post-dx 1992–2002 3y post-dx % COL 12/18/36m post-dx 26/54/70% COL 1 or 3y post-dx
(referenced 1997 AGA; 1999, 2000 ASCO; 2001, 2003 ACS; 2003 AGA; 2004 ASCRS)
Cooper (2008) SEER-Medicare n = 9,426; 55% female; 87% White Medicare beneficiaries; ≥66y; treated w/curative intent; alive 3.5y post-dx 2000–2001 42m post-dx % OV/COL/CEA 42m post-dx 92/74/47% ≥2 OV/y; ≥1 COL w/in 3y; ≥2 CEA in y1 & y2
(referenced 1989 AGA, ASGE; 1999, 2000, 2005 ASCO; 2004 ASCRS; 2006 ACS, ASGE, USMTFCC; 2008 NCCN)
% testing below/at/above recommended levels 60/17/23%
Ellison (2003) SEER-Medicare n = 52,105; 53% female; 86% White Medicare beneficiaries; ≥65y; stage I-III CRC; treated w/ curative intent 1986–1996 Through 998 % CE 18m/3y/5y post-tx 57/67/74% NR/NR
Elston Lafata (2001) Medical records n = 251; mean age 65y; 62% male; 63% White; HMO members ≥40y; stage I-III CRC; treated w/ curative intent 1990–1995 8y post-dx % CE 18m/3y/5y post-tx 55/65/77% CE (COL, SIG & BE, BE only) 1y post-tx, every 3–5y thereafter
(referenced 1992 ASCRS; 1996 NCCN; 1997 AGA; 1999 ASCO)
% CEA 18m/3y/5y post-tx 71/79/87%
Elston Lafata (2005) Medical records n = 100; 56% male; 68% White; HMO members Enrolled ≥ 1y or ≥1 PCP visit pre-dx; ≥30y; new primary CRC; alive ≥6m post-dx 1990–1995 5y post-dx % PE 18m post-tx/within 18m of initial 78/85% 2 PE/y, 1 CE (COL, SIG, or BE) in y1 & y3-y5
% CE 18m post-tx/within 18m of initial 61/62% 4 CEA/yr
(based on 1999 ASCO; 2001, 2002 NCCN)
% CEA 18m post-tx/within 18m of initial 17/12%
Foley (2011) State cancer registry-Medicaid n = 1,044; <65 to ≥75y; 68% female; 57% White Medicaid beneficiaries; stage I to III CRC; alive ≥18m post-dx 1999–2002 18m post-tx % COL/CEA 3–18m post-tx 42/25% COL 1y post-tx
(referenced 1999 ASCO; 2008 ACS, USMTFCC, ACR)
Fox (2013) Military Health System claims data (TRICARE) n = 345; 73% ≥50y; 55% male; 62% Southern US region 18 to 61y; underwent curative treatment for CRC; enrolled in TRICARE Prime managed care program; ≥ 1 health claim per year 2005–2007 Through Sept 2010 % PE 1y/2y/3y follow-up 95/93/89% 1y follow-up: 2 PE, 2 CEA, 1 COL
% PE each year 52%
% CEA 1y/2y/3y follow-up 59/49/43% 2y follow-up: 2 PE, 2 CEA
% 1+ COL in 3y 69% 3y follow-up: 2 PE, 2 CEA
(based on 2009 NCCN)
% all recommended care each year 26%
High-cost imaging:
% PET 1y/2y/3y/overall		 16/14/11/24%
% CT 1y/2y/3y/overall 60/54/50/78%
% MRI 1y/2y/3y/overall 18/15/15/35%
Haggstrom (2009) Cross-sectional survivor survey n = 416; 52% ≥65y; 52% male; 70% White No treatment in past 6m; no evidence of recurrence 1999–2001 April 2003–Nov 2004 % 1/2/≥3 OV in past 12m 27/34/39% Regular history and physicals during the first 3 years post-tx
(referenced 2005 ASCO)
Hilsden (2004) Provincial cancer registry linked with ministry of health admin databases and medical records n = 3918; 46% ≥ 70y; 56% male; 85% rural residence; Canadian sample ≥30y; first CRC treated w/curative resection; survived ≥270d post-surgery; eligible for Alberta insurance plan at dx; able to be linked to admin databases 1983–1995 Through March 2000 % COL within 5y post-tx 51% NR/NR
Hu (2011) SEER-Medicare n = 7,348; 60% female; 89% White Medicare beneficiaries; ≥66y; stage I-III CRC; treated w/ curative intent w/in 3m of dx; alive 3.5y post-tx 2000–2002 Through 2005 % OV 1/2/3y post-tx 93/88/84% ≥2 OV/y for 3y; ≥2 CEA/y for 2y; ≥1 COL w/in 3y (referenced 1999 ASCO; 2010 NCCN)
% CEA 1/2y post-tx 42/29%
% COL 1/2/3y post-tx 59/68/74%
% testing at recommended levels 25%
Jackson (2010) Medical records n = 2,492; 98% male; 72% White; VA patients Stage I-III CRC; treated w/ curative intent 2003–2006 Through March 2006 % COL 7–18m post-tx 44% COL 7–18m post-tx (based on 2003 NCCN)
Knopf (2001) SEER-Medicare n = 52,283; 53% female Medicare beneficiaries; ≥65y; stage I-III CRC; treated w/curative intent 1986–1996 Through 1998 % CE 1y/1–4y/ 4–7y/7+y post-dx 46/48/40/31% CE (COL, SIG, or BE) 1y post-tx & every 3–5y thereafter
(referenced 1989 AGA, ASGE; 1996 NCCN; 1997 ACS, AGA; 1999 ASCO)
% testing below/above recommended levels 17/18%
Parsons (2012) SEER-Medicare n = 17,906; 59% female; 85% White Medicare beneficiaries; ≥ 66y; stage III CRC; treated w/curative intent 1992–2007 3y post-tx % COL/CEA 3y post-tx 49/72% COL w/in 3 y post-tx
Any CEA w/in 3 y post-tx
(referenced 2003 GCP; 2005 ASCO; 2006 ACS, USMTFCC; 2007 NCCN)
Pollack (2009) SEER-Medicare along with UPIN registry and AMA Physician file n = 16,671; 86% 65+y; 56% female; 86% White; 84% metropolitan residence First CRC dx at ≥ 60y; survived ≥ 5y; no recurrence or multiple cancers 1992–1997 Through Dec 2003 % PV with cancer specialist 28% ≥ 1 PV during 6th to 12th year post-dx
(basis for adherence definition not reported)
% PV with hematologist/oncologist 26%
% PV with radiation oncologist 2%
% PV with surgical oncologist 1%
% PV with gynecologic oncologist 0.2%
% PV with cancer-related specialist 37%
% PV with general surgeon 8%
% PV with colorectal surgeon 6%
% PV with gastroenterologist 26%
% PV with PCP 73%
% PV with medical specialist 66%
Ramsey (2007) SEER-Medicare n = 28,209; 52% female; 86% White Medicare beneficiaries; ≥ 65y; stage I-III CRC; treated w/ curative intent 1986–1996 Through 2003 % testing below/at/above recommended levels 47/25/28% ≥ 1 CE (COL, SIG, or BE) over study period
(referenced 2006 ACS, USMTFCC)
Rolnick (2005) Medical records n = 881; 48% ≥ 70y; 57% male; 75% White; HMO members ≥ 40y; stage 0-III CRC; White or African-American 1990–2000 5y post-tx % CE 1/3/5y post-tx 18/60/67% CE (COL or SIG & BE) 1, 3, & 5y post-dx
(referenced 1989 AGA, ASGE; 1996 NCCN; 1997 AGA; 1999, 2000 ASCO; 2003 AGA)
Rulyak (2004) Medical records linked with SEER n = 1,002; <50 to 80+y; 50% male; 93% White; HMO members Stage 0-III new primary CRC 1993–1999 8.7y post-dx % CE 18m post-dx/within 18m of initial/5 y post-dx 61/38/80% NR/NR
Rulyak (2007) Medical records linked with SEER n = 1002; 78% ≥ 60y at dx; 50% male; 93% White; HMO members Stage 0-III; treated w/curative intent; survived ≥ 6m post-dx 1993–1999 Through Dec 2001 % ≥ 1 CE during study period 65% NR/NR
Mean exams during study period 1.4
% CE 18m/5y post-dx 61/80%
Salloum (2012) Medical records linked to tumor registry n = 2,297; mean age 68.6y; 51% female; 81% White; HMO members ≥ 18y; enrolled in HMO plan ≥ 1y pre-dx; treated w/curative intent 2000–2008 8y post-dx % PE 18m post-tx/within 18m of initial 98/91% 2 PE 18m post-tx; 1 CE (COG, SIG, or BE)
% CE 18m post-tx/within 18m of initial 55/16.7% 18m post-tx
(based on 2011 NCCN; 1999 ASCO)
Salz (2010) Medical records n = 1,423 56% ≥ 65y; 56% male; 67% White; multi-region cohort including VA & managed care patients Stage I-III CRC; treated w/curative intent w/in 1m of dx; alive 14m post-tx w/out recurrence 2003–2005 15m post-dx % COL 14m post-tx 49% COL 14m post-tx
(based on 2003 ACS; 2006 ACS, NCCN, USMTFCC)
Singh (2013) SEER-Medicare n = 70,419; 36% ≥ 80y; 55% female; 85% White ≥ 66y; stage I-III CRC; no history of IBD; Medicare beneficiaries enrolled in Part A & B; not HMO members 1992–2005 1992–2003 (second COL cohort), 1992–2002 (third COL cohort) % early surveillance COL after first/second normal COL 32/27% COL 1y post-tx, 3- and 5y later
Median time between first and second COL 29m “Early surveillance”: COL 3m to 2y after previous COL
Median time between second and third COL 33m (referenced 1997 AGA, 2000 ASCO, 2004 ASCRS, 2006 USMTFCC)
Sisler (2012) Provincial cancer registry linked with pop health research data n = 250; median age = 70y; 53% male; Canadian sample Stage II and III new CRC; treated with definitive surgery; alive 42m post-dx 2004 July 2004–June 2008 % COL within 3y period 80% At least 1 COL in 3y study period; at least 1 liver imaging (CT, US, or MRI of the abdomen) in each 1y interval; at least 3 CEA tests in each 1y interval (based on 2005 ASCO)
% liver imaging (CT, US, or MRI) in each 1y interval 47%
% CEA in each 1y interval 22%
% adherent to all 3 tests over study period 12%
Spratlin (2008) Provincial cancer registry along with medical records n = 152; mean age 66y; 66% male; 57% stage II; Canadian sample Resected stage II/III CRC w/clear surgical margins; discharged to community; no second malignancy ≤5y post-dx 2001 3y post-dx % minimum CEA follow-up 7% CEA every 4m for ≥2y
(based on clinical practice and informed by 2000 ASCO)
a

Adherence to surveillance was judged according to the particular guideline(s) mentioned in the individual studies. Individual studies’ definitions of adherence varied. The majority of studies explicitly stated that they based their definition of adherence on a specific guideline(s) (n = 12), yet other studies only referenced published guidelines (n = 12). A few studies did not provide any basis for the definitions of adherence (n = 7).

ABBREVIATIONS: CRC, colorectal cancer; d, days; m, months; y, years; admin, administrative; comm, community; pop, population; post-dx, post-diagnosis; post-tx, post-treatment; NR, not reported; OV, office visits; PE, physical examination; CE, colon examination (i.e., colonoscopy, sigmoidoscopy, and/or barium enema; majority of exams, 77–99%, were colonoscopy); COL, colonoscopy; SIG, sigmoidoscopy; BE, barium enema; CEA, carcinoembryonic antigen test; CBC, complete blood counts; CT, computed tomography; CXR, chest x-rays; LFT, liver function tests; US, ultrasound; OMD, other metastatic disease testing (e.g., x-ray, ultrasound, CT scan, MRI ); ACR, American College of Radiology; AMA, American Medical Association; AGA, American Gastroenterological Association; ASCO, American Society of Clinical Oncology; ASCRS, American Society of Colon and Rectal Surgeons; ASGE, American Society for Gastrointestinal Endoscopy; CanCORS, Cancer Care Outcomes Research and Surveillance Consortium; HMO, health maintenance organization; IBD, inflammatory bowel disease; NSABP, National Surgical Adjuvant Breast and Bowel Project; NCCN, National Comprehensive Cancer Network; SSO, Society of Surgical Oncology; USMTFCC, United States Multi-Society Task Force on Colorectal Cancer; GCP, Gastrointestinal Consortium Panel; UPIN, Unique Physician Identification Number.