Introduction

With improvements in outcomes and the aging population, the number of colorectal cancer survivors is increasing, challenging health services to provide effective and efficient follow up care.  Such care should address early detection of recurrent and new cancers, management of long term and late effects (psychosocial and physical effects), as well as secondary prevention. Australian and international clinical practice guidelines present diverse recommendations about the timing and nature of follow up care, but little is known about what is being implemented in routine clinical practice.

Aims

To investigate survivorship care received and recommended among a population-based sample of colorectal cancer survivors across New South Wales (NSW).

Methods

Mailed survey of patients notified to the NSW Central Cancer Registry between 29 November 2012 and 31 May 2013.  Patients completed questionnaires at baseline and 12 months, with questions about survivorship care included in the follow-up survey.

Results

Of 1027 patients contacted, 560 participated (55%) at baseline and 484 (86% of baseline participants, 47% of invited sample) at 12 months.  There were high rates of ongoing care from multiple health professionals: 80% continued to see a surgeon and 71% their general practitioner for colorectal cancer follow up.  Only 23% had received a written survivorship care plan, more commonly migrants, non-urban dwellers and those with little experience of the health system.  Despite the large number of follow up contacts, guideline-concordant surveillance investigations (colonoscopy and carcino-embryonic antigen assay) were reported by less than half, more commonly among those with private health insurance.  Patients reported high interest in improving general health and lifestyle since their cancer diagnosis but few had received advice about screening for other cancers or assistance with issues such as diet and physical activity. 

Conclusions

Survivorship care for colorectal cancer in NSW is highly variable, with missed opportunities for health promotion.