Colon Cancer's Spread Often Unchecked
More Than 60% of U.S. Hospitals Fail Guidelines for Checking the Spread of Colon Cancer
"Having the pathologist in direct conversation with the surgeon is an important thing. And the diligence with which the pathologist examines the specimen is a real critical component," Brooks tells WebMD. "We have made an extra effort to have a very integral conversation between a patient's medical oncologist, the surgeon, and the pathologist."
It works. Bilimoria says that 10 years ago, his hospital met the guideline no more than half the time. Now they meet it every year -- and are looking for the same kind of improvement in other types of cancer.
Care Bad for 60% of Colon Cancer Patients
Problems don't end even when colon cancer is properly diagnosed and treated.
More than 60% of colon cancer patients don't get proper follow-up care, find Gregory S. Cooper, MD, and colleagues at Cleveland's Case Western Reserve University.
That care is crucial, Cooper says, because 30% of patients have their cancer come back within five years of surgery. Quick detection of that second cancer results in a much better outcome.
In a study of nearly 10,000 elderly colon cancer patients covered by Medicare, the researchers found that 92% of patients regularly returned to their doctors for check-ups.
But more than one in four patients didn't get a follow-up colonoscopy within three years. (Current recommendations are to get one a year after surgery, and, if negative, every three years after that.)
Worse still, more than half of patients -- 53% -- didn't get even minimal blood tests (the CEA test) to see whether cancer might be spreading in their bodies.
"I would put most of the blame on the clinicians treating these patients," Cooper tells WebMD. "Colon cancer survivors must ask their doctors: Should I be having a blood test for cancer spread? When should I have my next colonoscopy?"
Ochsner's Brooks says it's crucial for patients who have had cancer to continue to get top-notch care from their doctors.
"Cancer isn't like appendicitis, where you get an operation and then go on with your life," Brooks says. "There are complications from treatment, complications from the disease -- and people do get second cancers. It is crucial they get follow-up care. I have worked here for 22 years, and have patients with second, third, and fourth cancers. And they're still coming in to see me."
The Bilimoria study appears in the Sept. 17 issue of the Journal of the National Cancer Institute. The Cooper study appears in the Oct. 15 issue of the journal Cancer.