Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #109095

Frank E. Johnson, MD¹, Paul A. Lee, MD¹, Alaine E. McGarry, MS¹, Steven R. Gammon, BS¹, Erik M. Grossmann, MD¹, Walter E. Longo, MD², Kenichi Ode, MBChB³, Riccardo A. Audisio, MD³, Umar S. Shariff, MBChB⁴, Trifonas Papettas, MBChB⁴, and Katherine S. Virgo, PhD¹. (1) Department of Surgery, Saint Louis University and Department of Veterans Affairs Medical Center, 3635 Vista Avenue, St. Louis, MO 63110-0250, (314) 577-8316, frank.johnson@med.va.gov, (2) Department of Surgery, Yale University, 333 Cedar Street, New Haven, CT 06520, (3) University of Liverpool, L69 3BX, Liverpool, United Kingdom, (4) University of Sheffield, S10 2TN, Sheffield, United Kingdom

Overuse, underuse, and misuse of resources is common in medical care. Efforts to minimize inappropriate use are widely advocated. We targeted the use of resources by surgeons caring for rectal carcinoma patients and measured the intensity of post-treatment follow-up via a survey of the membership of the American Society of Colon and Rectal Surgeons (ASCRS). All 1795 members were asked, via a detailed questionnaire, how often they request 14 discrete follow-up modalities (office visit, 3 specific blood tests, and 9 specific imaging tests) in their patients treated for cure with TNM stage I, II, or III rectal cancer over the first 5 post-treatment years. There were 347 evaluable responses. Most respondents were 40-60 years of age and > 90% had completed fellowship training in colorectal surgery or surgical oncology. Members of the ASCRS often follow their own patients post-operatively rather than delegating this to others. Office visit is the most frequently requested item for each of the first 5 post-operative years (mean ± SD = 3.8 ± 2.7 visits in post-operative year 1 after radical surgery for stage I lesions, diminishing to 1.5 ± 1.0 visits in year 5). The substantial variation in follow-up intensity among these experts is of concern. Investigation of the sources(s) of this variation is warranted; much of it probably reflects the absence of high-quality evidence supporting any particular follow-up plan. These survey data permit the rational design of a randomized clinical trial of two alternative follow-up strategies.

Learning Objectives:

• At the conclusion of this session, the participant (learner) will be able to discuss the current practices of surgeons managing patients after potentially curative surgery for rectal carcinoma and identify factors that could account for variation in self-reported follow-up practice patterns.

Keywords: Cancer Screening, Surveillance

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.