Surveillance for colorectal cancer survivors in an integrated safety-net health system in the United States

Introduction: Guideline-recommended surveillance reduces the likelihood of colorectal cancer recurrence, yet surveillance rates are low in the United States. Little is known about colorectal cancer surveillance rates among patients without health insurance and their primary care clinicians/oncologists' attitudes toward surveillance care. Methods: A retrospective study of 205 patients diagnosed with Stage I-III colorectal cancer from 2008 to 2010 was conducted in an integrated system with a network of clinics and health care providers, delivering care to patients lacking health insurance coverage. Surveillance patterns were characterized from medical records, and logistic regression models examined correlates of guideline-concordant surveillance. Forty-four Parkland primary care physicians (PCPs) and 24 oncologists completed surveys to assess their attitudes and practices regarding colorectal cancer surveillance. Results: Thirty-eight percent of colorectal cancer patients received guideline-concordant surveillance; those with early stage cancers were less likely to receive surveillance (odds ratio = 0.35; 95 confidence interval: 0.14, 0.87). PCPs and oncologists differed markedly on who is responsible for cancer surveillance care. Seventy-seven percent of oncologists responded that PCPs evaluated patients for cancer recurrence, while 76% of PCPs responded that these services were either ordered by oncologists or shared with PCPs. Sixty-seven percent of oncologists said that they rarely provide a treatment and surveillance care plan to survivors, and over half said that they infrequently communicate with patients' other physicians about who will follow patients for their cancer and other medical issues. Discussion: Care coordination between PCP and oncologist is needed to improve colorectal cancer surveillance. New models of shared care clearly delineating roles for oncologists and PCPs are needed to improve colorectal cancer survivorship care.