Optimising Colorectal Cancer Care in Western Australia: Surveillance and Recurrence Insights

BACKGROUND: Colorectal cancer (CRC) is a leading malignancy in Australia, with many patients undergoing curative surgery for stage I-III disease. Despite treatment advances, recurrence remains a significant cause of mortality. This study assessed recurrence rates, survival and surveillance adherence across three public tertiary centres in Western Australia. METHODS: A retrospective cohort study was conducted on 459 stage I-III CRC patients who underwent curative resection between 2012 and 2013. Data on patient demographics, pathological features, surgical metrics, adjuvant therapy, survival and surveillance adherence were examined. Recurrence rates were analysed using univariate and multivariate logistic regression. RESULTS: Recurrence rates varied significantly (p = 0.007) across hospitals, highest at Hospital C (26.2%) and lowest at Hospital A (11.4%). Most recurrences (80%) occurred within 3 years, with a median time to recurrence of 1.6 years. Routine surveillance detected 78% of recurrences, but adherence was inconsistent, with non-adherence rates of 55.6% at Hospital C, 38.9% at Hospital B, and 5.6% at Hospital A. At 5 years, overall survival was 65.6%, disease-free survival 58.8%, and cancer-specific survival (CSS) 73.9%, with Hospital C showing significantly lower CSS (68.3%, p = 0.014). Multivariate analysis identified younger age (50-59 years, OR = 0.33, p = 0.01), Stage I disease (OR = 0.33, p = 0.04), and treatment at Hospital A (OR = 0.36, p = 0.004) as protective factors against recurrence. CONCLUSION: Significant variation in recurrence rates, survival, and surveillance adherence across institutions underscores the need for optimised, standardised follow-up protocols. More structured, centralised tracking systems may improve adherence and long-term outcomes for CRC patients.