CURRENT PRACTICE OF FOLLOW-UP MANAGEMENT AFTER POTENTIALLY CURATIVE RESECTION OF RECTAL CANCER

Transcription

1 CURRENT PRACTICE OF FOLLOW-UP MANAGEMENT AFTER POTENTIALLY CURATIVE RESECTION OF RECTAL CANCER 1. a. If you are retired, or do not perform such surgery, please check the box at the right, answer questions 2-7, and return the blank survey in the enclosed envelope. b. If you do not provide long-term postoperative follow-up for your patients, please check the box at the right, answer questions 2-8, and return the blank survey in the enclosed envelope. c. If you perform rectal cancer surgery and follow some or all of your patients, please check the box at the right, complete the survey, and return it in the enclosed envelope. 2. Your age is: less than You completed residency training how many years ago? years ago 4. You completed a residency in: General surgery 5. You have completed fellowships in: Other: Colon and Rectal Surgery Surgical Oncology None Other: 6. In addition to the ASCRS, you are a member of the: Society of Surgical Oncology American Society of Clinical Oncology Other: 7. Your practice is primarily: private academic government (e.g., VA, PHS, NHS) 8. Treatment of rectal cancer constitutes approximately what percent of your practice? <1% 1-5% 6-10% % >50% For Internal Use Only

2 9. In the tables on pages 2-5, please enter the number of times per year (0-99) you recommend each diagnostic modality. If you do not recommend a given test in a given year, please enter zero for that year. Do not leave any boxes blank. DO NOT USE THE ENTER KEY. USE TAB ONLY TO MOVE BOX TO BOX. Always consider follow-up as beginning at the completion of all adjuvant therapy. a. Consider an otherwise healthy patient who has just undergone uncomplicated, potentially curative LOCAL THERAPY (local excision, contact radiotherapy, cryosurgery) of a Stage I (T1-2 NO MO) rectal carcinoma. I would recommend: POST-OPERATIVE YEAR Office visit (including rectal exam, if indicated) Serum CEA level Flexible sigmoidoscopy Intrarectal ultrasound CT of abdomen/pelvis CT of chest MRI of abdomen/pelvis Other (please describe):

3 b. Consider an otherwise healthy patient who has just undergone uncomplicated, potentially curative RADICAL SURGERY (Proctectomy with colorectal or coloanal anastomosis or proctectomy with abdominoperineal resection) of a Stage I (T1-2 N0 M0) rectal carcinoma. Always consider follow-up as beginning at the completion of all adjuvant therapy. DO NOT USE THE ENTER KEY. USE TAB ONLY TO MOVE BOX TO BOX. I would recommend: POST-OPERATIVE YEAR Office visit (including rectal exam, if indicated) Serum CEA level Flexible sigmoidoscopy Intrarectal ultrasound CT of abdomen/pelvis CT of chest MRI of abdomen/pelvis Other (please describe):

4 c. Consider an otherwise healthy patient who has just undergone uncomplicated, potentially curative RADICAL SURGERY (Proctectomy with colorectal or coloanal anastomosis or proctectomy with abdominoperineal resection) of a Stage II (T3-4, N0 M0) rectal carcinoma. Always consider follow-up as beginning at the completion of all adjuvant therapy. DO NOT USE THE ENTER KEY. USE TAB ONLY TO MOVE BOX TO BOX. We realize that treatment in this group may include adjuvant therapy and we ask that you consider your follow-up surveillance plan as beginning at the completion of all adjuvant therapy. I would recommend: POST-OPERATIVE YEAR Office visit (including rectal exam, if indicated) Serum CEA level Flexible sigmoidoscopy Intrarectal ultrasound CT of abdomen/pelvis CT of chest MRI of abdomen/pelvis Other (please describe):

5 d. Consider an otherwise healthy patient who has just undergone uncomplicated, potentially curative RADICAL SURGERY (Proctectomy with colorectal or coloanal anastomosis or proctectomy with abdominoperineal resection) of a Stage III (T1-4, N1-2 M0) rectal carcinoma. Always consider follow-up as beginning at the completion of all adjuvant therapy. DO NOT USE THE ENTER KEY. USE TAB ONLY TO MOVE BOX TO BOX. We realize that treatment in this group may include adjuvant therapy and we ask that you consider your follow-up surveillance plan as beginning at the completion of all adjuvant therapy. I would recommend: POST-OPERATIVE YEAR Office visit (including rectal exam, if indicated) Serum CEA level Flexible sigmoidoscopy Intrarectal ultrasound CT of abdomen/pelvis CT of chest MRI of abdomen/pelvis Other (please describe):

6 10. a. Consider a generally healthy patient who returns two years after potentially curative low anterior resection of a T3 N0 M0 adenocarcinoma of the rectum. No adjuvant therapy was given. He/she now has a serum CEA level of 8 ng/dl. The patient states he/she feels well overall. What would be your initial workup? Please indicate all tests or procedures that you would perform prior to definitive therapy. Repeat CEA level CT of the abdomen/pelvis CT of the chest MRI of the abdomen/pelvis Other (specify):

7 b. Consider a generally healthy patient who returns two years after potentially curative low anterior resection of a T3 N0 M0 adenocarcinoma of the rectum. No adjuvant therapy was given. On routine follow-up chest x-ray he/she now has four cm radiodensities in both lung fields suggestive of metastases. He/she has a serum CEA level of 1.4 ng/dl. The patient states he/she feels well overall. His/her physical examination is unremarkable. Which of the following studies would you use in your initial workup? (Indicate all that apply.) Repeat CEA level CT of the abdomen/pelvis CT of the chest MRI of the abdomen/pelvis Other (specify):

8 11. Many factors motivate physicians performing postoperative surveillance. Please rate each factor listed below in terms of its importance to you by entering the appropriate number. Least Important Average Importance Most Important Sample of rating scale: Early detection of recurrence Detection of second primary colorectal cancer Detection of other cancers Patient education Assessment of results of treatment Psychosocial support Risk counseling for family members Avoidance of medical malpractice lawsuits Maintenance of rapport with referring physicians Patient/family requests Reported survival benefits of follow-up in the medical literature Other (please specify):