Final Research Report

View this project's final research report.

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Videos

Studying the Frequency of Testing for Colorectal Cancer Survivors (right)
Principal Investigator George Chang discusses this project, which examined whether the frequency of follow-up testing of colorectal cancer survivors had an effect on the detection of recurrence or survival.

Benefits and Drawbacks of Cancer Surveillance
Principal Investigator George Chang shares some of the most common benefits and drawbacks of cancer surveillance, including patient anxiety.

Webinars

How Frequently Should Cancer Survivors be Screened for Disease Recurrence? Is More Always Better?
In August 2019, the National Alliance of Healthcare Purchaser Coalitions hosted a webinar discussion about the frequency of testing and screening practices following surgery for colorectal cancer. The webinar featured George J. Chang, MD, MS, who discussed his findings’ possible impact for employers and influence on medical guidelines, and compared current US practices in relation to other countries.

Journal Citations

Article Highlight: For patients who have surgery to remove colorectal tumors, reoccurrence of tumors is a major concern. Researchers in this study reported in JAMA that healthcare facilities that do more-frequent surveillance failed to detect recurring cancers any sooner than facilities that do less-frequent surveillance. The study, which analyzed data from more than 8,000 patients, also found no link between the intensity of surveillance and overall survival, suggesting more-frequent surveillance provided no health benefit.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • The reviewers asked why the analyses did not connect the intensity of cancer surveillance at the individual patient level directly, rather than at the facility level. The researchers indicated that individual patients’ surveillance intensity typically was related to their risk of recurrence, thus leading to potential bias at the individual patient level.
  • Since the study observed no difference in survival based on surveillance intensity, the reviewers said it would have been interesting to include patients who did not have any surveillance. The researchers said their study excluded patients who received no surveillance because that is not in line with recommended practice and is often associated with patient factors that could bias findings.
  • The reviewers said it would be helpful to see an economic analysis of the difference between high-intensity and low-intensity surveillance facilities since the study implies that the low-intensity facilities provided similar quality of care more efficiently. The researchers said an economic analysis was beyond the scope of this study and would have been difficult to conduct given the lack of identifying information collected about patients. An analysis of costs to operate high- versus low-intensity surveillance facilities would also fall outside of PCORI’s restrictions on funding cost effectiveness research.
  • The reviewers asked the researchers to justify combining colon and rectal cancer outcomes, since these are distinct diseases with different treatments and prognoses. The researchers said that despite the differences between them, the follow-up strategies for the two diseases are the same, and the two surveillance intensity groups had a balanced number of colon and rectal cancer patients.

Conflict of Interest Disclosures

Project Information

George J. Chang, MD, MS
The Alliance for Clinical Trials in Oncology Foundation
$1,826,664
10.25302/04.2020.CE.13046855
Patient-Centered, Risk-Stratified Surveillance After Curative Resection of Colorectal Cancer

Key Dates

September 2013
June 2019
2013
2019

Study Registration Information

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Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 4, 2022