Fewer than half of older patients treated for colorectal cancer in the U.S. received the recommended screenings to detect whether the cancer has recurred, a new study suggests.

People who have had surgery to treat colorectal cancer are at increased risk of recurrence. To reduce the risk, professional gastroenterology associations in Canada and the U.S. recommend a combination of checkups, colonoscopy and other tests to detect changes that could signal a recurrence.

To see how well the recurrence guidelines are followed, Dr. Gregory Cooper, a gastroenterologist at University Hospitals Case Medical Center in Cleveland and his colleagues analyzed information from more than 9,400 patients over 65 who were diagnosed with adenocarcinoma of the colon or rectum from 2000 to 2001.

Expert puts most of blame on doctors

In the Oct. 15 issue of the journal Cancer, the team reported that 60 per cent of patients received testing below recommended levels, and 17 per cent received testing at the recommended frequency, based on their analysis of national cancer registries and Medicare claims in the U.S.

The guidelines were considered fulfilled if a patient had:

• Two or more office visits per year after cancer surgery.
• Two or more carcinoembryonic antigen (CEA) blood tests per year to detect a protein associated with tumours.
• At least one colonoscopy within three years.

Nearly 23 per cent of people received followup services beyond those specified in the guidelines, such as CT or PET scans that are generally not recommended, the researchers said.

It's not known whether doctors didn't offer the tests or patients failed to get them. Followup care could be provided by doctors who aren't specialists and are unfamiliar with the guidelines.

"I would probably put most of the blame on the providers," said Cooper.

Findings don't surprise cancer society medical officer

Some of the difference could be explained by clinical factors such as the stage of disease.

"Further studies should ascertain the reasons for poor compliance and the effect on patient outcome," the study's author wrote.

Use of testing was generally lower among African Americans, "which is likely a contributing factor" in why the group often shows poorer survival compared to Caucasians who are at the same stage of disease, the researchers said.

"Quite honestly, I'm sorry to say, I'm not surprised about the findings," said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, which funded the study.

Despite advanced medical technology, "our ability to deliver the recommended care to patients has left something to be desired."

With files from the Associated Press