Frequent CEA measurements in follow-up of colorectal carcinoma.

In this prospective randomized trial, a new follow-up protocol for patients curatively treated for colorectal cancer (CRC) is introduced. A national guideline for follow-up after CRC already exists, but adherence to this guideline is variable.

In the study, 10 Dutch hospitals will participate. Randomization is on hospital level, which practically means that a hospital is performing follow-up in the way it's used to, and after randomization, all patients in that hospital will participate in the new schedule, resulting in the fact that the last-randomized hospital will produce a large dohort of control group and a small cohort of intervention group patients.

In the intervention group, CEA will be measured more frequently and further imaging will be performed in case of rise in CEA. Of course regular imaging using CT scan and colonoscopy will be performed as well.

In monitoring this follow-up, a software tool called CEA-watch is used, which attends the surgeon when a patient has an increased CEA value and can easily produce letters and emails for informing patients.

Aim of this study is to find metastatic disease earlier than in regular follow-up, thereby increasing the chance to curatively treat these metastases.

The percentage of curatively treatable metastatic disease after surgery for primary colorectal cancer can be increased by means of optimizing follow-up of colorectal carcinoma. Intensifying the follow-up by increasing frequency of CEA measurements, and performing CT scans if CEA rises, will reach the increase of this percentage. Curable treatment of metastatic disease is known to be associated with longer survival.

1. 1-10-2010: Start interventions schedule in firstly randomized participating hospitals;

2. 1-10-2011: Start intervention schedule in last randomized participating hospitals;

3. 1-7-2012: Stop intervention.

After randomization at hospital level, all patients in that hospital will participate in the new follow-up scheme. This consists of increasing of the frequency of CEA measurement, and of performing an additinal CT scan if CEA values has risen significantly.

All patients in the intervention group will be imported in a software program, which exactly follows all CEA values and gives information on rise in CEA. Thereby the program is able to inform the patients of their CEA values quickly. Using this software has shown to reduce the incidence of hospital visits for patients.