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. 2025 Mar;14(5):e70667.
doi: 10.1002/cam4.70667.

Follow-Up Adherence After Treatment With Curative Intent for Stage II and III Colorectal Cancer Patients

Tara C Boute  1 , Rik van Eekelen  1 , Marloes A G Elferink  2 , Lissenberg Witte Birgit 1st  1 , Johannes H W de Wilt  3 , Geraldine R Vink  2   4 , Marjolein J E Greuter  1 , Veerle M H Coupé  1
Affiliations

Follow-Up Adherence After Treatment With Curative Intent for Stage II and III Colorectal Cancer Patients

Tara C Boute et al. Cancer Med. 2025 Mar.

Abstract

Introduction: After colorectal cancer (CRC) treatment, patients undergo five-year follow-up involving carcinoembryonic antigen (CEA) tests, imaging, and colonoscopies. This retrospective cohort study explores adherence to the CRC follow-up guideline in the Netherlands until 2021 and its association with treatment of recurrences with curative intent.

Methods: Stage II/III CRC patients with recurrent disease within 3 years after diagnosis were selected from the Netherlands Cancer Registry (n = 430). Adherence to CEA tests, imaging, and colonoscopy was classified as 'according to/more follow-up' or 'less follow-up' than recommended. Logistic regression analyses examined factors associated with receiving less follow-up and the relationship between 'follow-up adherence' and 'treatment with curative intent', potentially mediated by 'mode of detection' (symptomatically vs. routine test).

Results: In total, 18.3% patients had fewer CEA tests, 41.4% fewer imaging, and 56.1% fewer colonoscopies than recommended. Factors associated with fewer follow-up moments were tumor localization, age (≥ 75 years), comorbidities, tumor differentiation and adjuvant chemotherapy. Patients receiving fewer CEA tests faced 4.8 times higher odds (95% CI: 2.9-8.1) of symptom-detected recurrence and were less likely to be curatively treated (OR = 0.5; 95% CI: 0.3-0.9). Mediation analysis indicated a significant average causal mediation effect (p = 0.003), emphasizing the mediating role of mode of detection. Receiving fewer imaging and colonoscopies showed insignificant total effects on treatment with curative intent.

Conclusion: Our findings offer insights into follow-up adherence, detection mode, and treatment with curative intent. The discovery that adherence was highest for CEA, along with the correlation between CEA adherence and treatment with curative intent, aligns with the recent adaptation of guidelines emphasizing CEA measurement over imaging.

Keywords: CEA; adherence; colorectal cancer (CRC); follow‐up.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Follow‐up adherence for (A) CEA measurements, (B) imaging tests, (C) colonoscopies and (D) all three modalities combined. Note that histogram C and D represent a subpopulation (n = 228) of patients who developed a recurrence after 15 months.
FIGURE 2
FIGURE 2
Relationship between CEA adherence and treatment intent of the recurrence (A), mediated by mode of detection (B).
See this image and copyright information in PMC

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