physician, PhD-student
Sinne Søberg Brun
Department of Radiology, Vejle Hospital
| Project management | ||
| Project status | Open | |
| Data collection dates | ||
| Start | 16.06.2025 | |
| End | 30.09.2027 | |
QUEST: QUality Evaluation of Surveillance CT in Colorectal Cancer Follow-Up - A Cohort Study on Detection of Recurrence and Incidental Findings
Short summary
The study compares the detection of recurrence rate on planned surveillance CT scans with unplanned imaging (CT, MRI, US) using 10 year data from the national Danish Colorectal Cancer database. Furthermore it assesses the incidence of incidental findings and their consequences for diagnostic strategies and patient outcomes.
Rationale
There is a continuous increase in diagnostic and treatment options in the Danish Healthcare System with significantly increase costs. National data show that the number of diagnostic imaging procedures have increased by 26% between 2011 and 2022. A Danish review from 2022 estimated that around 14% of CT scans were unnecessary, due to lack of clinical justification and consequence. Prioritizing diagnostic imaging is essential in order to provide clear clinical benefit and to avoid unnecessary imaging. The clinical justification and consequences of surveillance imaging in follow-up programs is often debated. There is a lack of evidence in overall survival and life quality benefit of routine surveillance imaging, even though programs are running in many clinical conditions. Curative treated colorectal cancer (CRC) patients are offered follow-up programs word wide, as CRC recurrence occurs in 30% of patients despite curative treatment with surgery and chemotherapy. Most recurrences are reported within the first three years of follow-up. CRC surveillance programs are considered relevant, because early detection of recurrence increases the potential for curative treatment. International guidelines vary in terms of the schedule of surveillance, but all recommend a combination of different tools with surveillance CT-scans as the major component. However, it is unclear how many recurrences are detected on surveillance CT-scans compared with unplanned diagnostic imaging performed for other reasons. The downside of surveillance imaging is the potential harms, leading to psychological distress from continued sickened of heathy individuals, recurrence fear, or early knowledge of incurable disease. Moreover, incidental findings such as lesions detected by diagnostic imaging, performed for another reason, result in further interventions with the increased complication risks and higher expenditures and time investment. The extent of incidental findings, which have significant clinical consequences for patients, is unknown. This quality assurance project aimed to assess: i) The incidence of CRC recurrence detected on planned surveillance CT compared with other unplanned diagnostic ii) The incidence, clinical relevance, and outcomes of incidental findings discovered on surveillance CT scans during the CRC follow-up program
Description of the cohort
The study population will include all patients with colon or rectal cancer stadium I-III treated at Lillebaelt Hospital between January 2015 and December 2024 and registered in the national Danish Colorectal Cancer Group (DCCG) database of high quality.
Data and biological material
The DCCG database will serve as the source for demographic data and clinical data associated to the participants, such as age, gender, death, BMI, smoking status, performance status, cancer type, pathology, tumour stage, surgery (type and date), chemotherapy, etc. Information regarding CRC recurrence and incidental findings will be collected from the electronic patient journals (RIS/PACS, EPJSyd and CosmicSyd).
Collaborating researchers and departments
Department af Radiology, Vejle Hospital
- Associate professor Malene Roland Vils Pedersen, PhD
- Professor Søren Rafael Rafaelsen, MD, PhD
Department af Oncology, Vejle Hospital
- Professor Torben Frøstrup Hansen, MD, PhD
Publications associated with the project