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WHICH FOLLOW-UP STRATEGY AFTER COLORECTAL CANCER TREATMENT?

The optimal treatment for malignant cancer is rarely clear-cut, but there is even less certainty about how to follow patients who have been potentially cured. This study calculated Medicare-allowed charges for 11 different surveillance strategies after treatment for colon cancer. The strategies were derived from medical research published between 1982 and 1994 and included specific follow-up recommendations; three strategies included the viewpoints of established medical societies. The lowest charge, $561, was for a protocol recommended by the American Society of Colon and Rectal Surgeons, which called for two barium enemas over five years. At the other end of the spectrum, totaling $16,492, was a comprehensive five-year regimen that included 14 office visits, fecal occult blood tests, complete blood cell counts, serum carcinoembryonic antigen tests, and chest x-rays; 8 colonoscopies; 5 abdominal CT scans; and 10 liver ultrasounds. Comment: These charge differences are striking, given that no follow-up strategy has ever been proven as superior to another. Rigorous evaluation of these protocols is needed so management can be standardized around cost-effective strategies.

— TH Lee

Published in Journal Watch General Medicine July 4, 1995

Citation(s):

Virgo KS, et al. Cost of patient follow-up after potentially curative colorectal cancer treatment. JAMA 1995 Jun 21 273 1837-1841.

• Medline abstract (Free)