TUESDAY, Sept. 9 (HealthDay News) -- Two new studies contain
disappointing news for people who've undergone colon cancer
treatment.
The first study, published in the Sept. 9 online edition of the
Journal of the National Cancer Institute (JNCI), found that just 38 percent of U.S. hospitals sampled were testing enough lymph nodes after colon cancer surgery to accurately assess the extent to which the disease had spread.
The second study, in the Oct. 15 issue of the journal
Cancer, found that only 40 percent of people who'd been successfully treated for colon cancer were receiving all of the recommended follow-up tests.
Of the first study, Dr. Durado Brooks, director of prostate and
colorectal cancer for the American Cancer Society, said, "It's
concerning that such a low percentage of hospitals are in
compliance."
And, Brooks said the second study "isn't the first that has
shown a lack of adequate surveillance after treatment. This study
shows the importance for patients to be educated about their
initial care and follow-up. It behooves patients to know what is
the appropriate follow-up."
Colon cancer is the second-leading cause of cancer death in the
United States, according to background information in the
JNCI study. As many as 80 percent of people diagnosed with
colon cancer have localized disease, which means at the time of
surgery, it appears that the cancer hasn't spread to other sites.
When colon cancer is surgically removed, surgeons also remove
surrounding lymph nodes to look for any signs that the cancer has
spread.
Guidelines recommend that at least 12 lymph nodes be examined
for cancer. If cancer is found in any lymph nodes, patients are
advised to undergo chemotherapy to try to keep the cancer from
spreading further. If no cancer is found in the lymph nodes, the
initial surgical treatment is generally the only treatment
needed.
"Examining 12 or more lymph nodes ensures adequate staging," said the lead author of the first study, Dr. Karl Bilimoria, a surgical resident at the Feinberg School of Medicine at Northwestern University in Chicago.
Bilimoria and his colleagues wanted to know how many hospitals
were actually adhering to these guidelines, and after reviewing
data from almost 1,300 U.S. hospitals they found that just 38
percent were compliant. The good news from this study is that the
number of compliant hospitals had increased by 23 percent since
1996. The bad news is that about 60 percent of hospitals aren't
checking enough lymph nodes to properly stage colon cancer.
The study also found that National Cancer Institute-designated
Comprehensive Cancer Centers were most likely to test 12 or more
lymph nodes, with 78 percent compliance. Veterans Administration
hospitals were next with 53.1 percent compliance, followed by
academic hospitals at 52.4 percent. Community hospitals were the
least likely to be compliant with just one-third checking 12 or
more lymph nodes after surgery.
"This is a feasible thing to do. It's not an unattainable benchmark," said Bilimoria, who added that he believes it may simply be a matter of making sure physicians and pathologists are educated on the guidelines.
In the meantime, he suggested that people undergoing colon
cancer surgery ask their doctor if they take out 12 or more lymph
nodes and ask for the pathology report to ensure that all have been
checked.
After successful treatment for colon cancer, patents should have
routine follow-up visits with their physician, blood tests and a
periodic colonoscopy.
In the second study, researchers found that 60 percent of the
9,426 colon cancer patients studied didn't receive all of the
recommended follow-up procedures. All the patients in the study
were older than 65 years old.
Most -- 92 percent -- saw their physicians for follow-up visits,
and 74 percent were tested for carcinoembryonic antigen (CEA), but
less than half underwent follow-up colonoscopy, according to the
study.
The study didn't look at the reasons behind the lack of
follow-up, so it's not clear whether doctors aren't recommending
the appropriate follow-up or if patients are choosing not get the
recommended follow-up care.
More information
To learn more about colon cancer and its treatment, visit the
U.S. National Cancer Institute.
