Volume 61 - 1998 - Fasc.1 - Symposium
Follow-up of colon cancer : detection of liver metastases : benefit and periodicity
The aim of a follow-up programme in patients with cancer is to detect relapse or metastases in an early asymptomatic stage. This is only useful if the diagnosis of recurrence has implications for treatment and if early treatment of recurrence leads to an improved prognosis. This is certainly the case for liver metastases of colon cancer. Surgical resection of localised liver metastases has a 25-30% 5-year survival. Early chemotherapy for non-resectable metastatic disease improves the survival and prolongs the symptom-free period in comparison with chemotherapy starting at the onset of symptoms. Follow-up for colorectal cancer should be offered to patients with the highest risk of recurrence and should consist of clinical examination, CEA monitoring, ultrasound of the liver, chest X-ray and periodic colonoscopy. Issues for further research are the determination of a follow-up programme with the highest sensitivity, the determination of the periodicity of follow-up, the search for prognostic factors for recurrence, cost issues and the final proof of a survival benefit in a large follow-up programme. Conclusions : Indirect evidence supports the need for a good follow-up programme for colorectal cancer focussing on the detection of liver metastases.
Cost benefit of longterm follow-up of uncomplicated Crohn's disease
Crohn's disease is a chronic disease with onset early in life and an unpredictable course with ups and downs during many years and perhaps lifelong. To my knowledge, only one study has been published about the medical cost for CD (1). This study used a literaturebased medical decision algorithm to estimate the expected costs of the illness per patient. From this study, it appears that surgery and hospitalization make up 70% of the total costs, medication I 10/c and outpatient medical care only 3%.
Outpatient medical care cost is principally determined by 4 factors 3
