This research project is in progress. PCORI will post its findings here within 90 days after our final review is complete. In the meantime, results have been published in peer-reviewed journals, as listed below.
Nearly 14 million Americans are alive today having survived their battle with cancer. Colorectal cancer (CRC) survivors make up the second largest group of cancer survivors, and the current population of 1.4 million colorectal cancer survivors is expected to grow nearly 25 percent by 2022. To these survivors and their family members and caregivers, as well as their physicians, the most pressing issue is determining the best way to monitor the survivor in the future. Cancer surveillance has been identified as a top priority by organizations such as the Institute of Medicine and the Agency for Healthcare Research and Quality. Despite differences in patients’ tumors and preferences, the available colorectal cancer surveillance guidelines take for the most part a one-size-fits-all approach. As a result, the quality of care, patient experience, and use of healthcare resources are compromised, and research to generate evidence and tools for improving colorectal cancer surveillance is greatly needed.
This proposal will address the critical question: “Based on my individual tumor characteristics, conditions, and preferences, what is the best way to monitor for recurrence?” We hypothesize that by tailoring the strategy for monitoring to the individual CRC survivors—taking into account their risk for recurrence, eligibility for salvage treatment, and personal preferences—the effectiveness of cancer monitoring would be improved and the burden on patients and the healthcare system would be reduced.
We specifically will
- determine how effective CRC surveillance is and measure the risk and time to recurrence and death—taking into account different patient and tumor characteristics—through detailed analysis of surveillance data from CRC clinical trials conducted by the ALLIANCE network, as well as from the National Comprehensive Cancer Network (NCCN) and the National Cancer Database (NCDB);
- identify key issues about CRC surveillance important to patients and clinicians through stakeholder engagement within the ALLIANCE network, as well as among patients at the University of Texas MD Anderson Cancer Center; and
- integrate the recurrence risk and patient priorities into a patient-centered, risk-stratified surveillance strategy by creating an interactive decision aid that can be easily accessed by patients and clinicians.
We will then design future studies to measure the impact of this tailored surveillance strategy, including the benefits, harms, and changes in resource utilization that occur when it is used in real-world situations. With a growing population of CRC survivors, the impact of cancer surveillance on patients and caregivers, physicians, and the healthcare system is great. The proposed research addresses an urgent and critical question these stakeholders now face each day with little information to guide their decisions. The knowledge gained by this proposal will provide important new tools to guide patients and their clinicians in making individualized decisions regarding cancer surveillance.
|Article Highlight: For patients who have surgery to remove colorectal tumors, reoccurrence of tumors is a major concern. Researchers in this study reported recently 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.|