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Colon Cancer Treatments Need Improvements

More lymph nodes should be checked, and follow-up care should be more frequent, studies find

TUESDAY, Sept. 9, 2008 (HealthDay News) -- Two new studies contain disappointing news for people who've undergone colon cancer treatment.

The first study, published in the Sept. 9 online edition of the Journal of the National Cancer Institute (JNCI), found that just 38 percent of U.S. hospitals sampled were testing enough lymph nodes after colon cancer surgery to accurately assess the extent to which the disease had spread.

The second study, in the Oct. 15 issue of the journal Cancer, found that only 40 percent of people who'd been successfully treated for colon cancer were receiving all of the recommended follow-up tests.

Of the first study, Dr. Durado Brooks, director of prostate and colorectal cancer for the American Cancer Society, said, "It's concerning that such a low percentage of hospitals are in compliance."

And, Brooks said the second study "isn't the first that has shown a lack of adequate surveillance after treatment. This study shows the importance for patients to be educated about their initial care and follow-up. It behooves patients to know what is the appropriate follow-up."

Colon cancer is the second-leading cause of cancer death in the United States, according to background information in the JNCI study. As many as 80 percent of people diagnosed with colon cancer have localized disease, which means at the time of surgery, it appears that the cancer hasn't spread to other sites. When colon cancer is surgically removed, surgeons also remove surrounding lymph nodes to look for any signs that the cancer has spread.

Guidelines recommend that at least 12 lymph nodes be examined for cancer. If cancer is found in any lymph nodes, patients are advised to undergo chemotherapy to try to keep the cancer from spreading further. If no cancer is found in the lymph nodes, the initial surgical treatment is generally the only treatment needed.

"Examining 12 or more lymph nodes ensures adequate staging," said the lead author of the first study, Dr. Karl Bilimoria, a surgical resident at the Feinberg School of Medicine at Northwestern University in Chicago.

Bilimoria and his colleagues wanted to know how many hospitals were actually adhering to these guidelines, and after reviewing data from almost 1,300 U.S. hospitals they found that just 38 percent were compliant. The good news from this study is that the number of compliant hospitals had increased by 23 percent since 1996. The bad news is that about 60 percent of hospitals aren't checking enough lymph nodes to properly stage colon cancer.

The study also found that National Cancer Institute-designated Comprehensive Cancer Centers were most likely to test 12 or more lymph nodes, with 78 percent compliance. Veterans Administration hospitals were next with 53.1 percent compliance, followed by academic hospitals at 52.4 percent. Community hospitals were the least likely to be compliant with just one-third checking 12 or more lymph nodes after surgery.

"This is a feasible thing to do. It's not an unattainable benchmark," said Bilimoria, who added that he believes it may simply be a matter of making sure physicians and pathologists are educated on the guidelines.

In the meantime, he suggested that people undergoing colon cancer surgery ask their doctor if they take out 12 or more lymph nodes and ask for the pathology report to ensure that all have been checked.

After successful treatment for colon cancer, patents should have routine follow-up visits with their physician, blood tests and a periodic colonoscopy.

In the second study, researchers found that 60 percent of the 9,426 colon cancer patients studied didn't receive all of the recommended follow-up procedures. All the patients in the study were older than 65 years old.

Most -- 92 percent -- saw their physicians for follow-up visits, and 74 percent were tested for carcinoembryonic antigen (CEA), but less than half underwent follow-up colonoscopy, according to the study.

The study didn't look at the reasons behind the lack of follow-up, so it's not clear whether doctors aren't recommending the appropriate follow-up or if patients are choosing not get the recommended follow-up care.

More information

To learn more about colon cancer and its treatment, visit the U.S. National Cancer Institute.

SOURCES: Karl Bilimoria, M.D., surgical resident, Feinberg School of Medicine, Northwestern University, Chicago; Durado Brooks, M.D., director, prostate and colorectal cancer, American Cancer Society, Atlanta; Oct. 15, 2008, Cancer; Sept. 9, 2008 Journal of the National Cancer Institute, online
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