Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States.
Abstract
BACKGROUND: Clinical practice guidelines recommend colonoscopies at regular intervals
for colorectal cancer (CRC) survivors. Using data from a large, multi-regional, population-based
cohort, we describe the rate of surveillance colonoscopy and its association with
geographic, sociodemographic, clinical, and health services characteristics. METHODS:
We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance
(CanCORS) study. Eligible survivors were diagnosed between 2003 and 2005, had curative
surgery for CRC, and were alive without recurrences 14 months after surgery with curative
intent. Data came from patient interviews and medical record abstraction. We used
a multivariate logit model to identify predictors of colonoscopy use. RESULTS: Despite
guidelines recommending surveillance, only 49% of the 1423 eligible survivors received
a colonoscopy within 14 months after surgery. We observed large regional differences
(38% to 57%) across regions. Survivors who received screening colonoscopy were more
likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90); have
visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82); and received adjuvant
chemotherapy (OR = 1.75, 95% CI: 1.27-2.41). Compared to survivors with no comorbidities,
survivors with moderate or severe comorbidities were less likely to receive surveillance
colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively).
CONCLUSIONS: Despite guidelines, more than half of CRC survivors did not receive surveillance
colonoscopy within 14 months of surgery, with substantial variation by site of care.
The association of primary care visits and adjuvant chemotherapy use suggests that
access to care following surgery affects cancer surveillance.
Type
Journal articleSubject
Attitude of Health PersonnelColectomy
Colonoscopy
Colorectal Neoplasms
Confidence Intervals
Continuity of Patient Care
Female
Follow-Up Studies
Guideline Adherence
Humans
Incidence
Male
Monitoring, Physiologic
Odds Ratio
Patient Compliance
Practice Guidelines as Topic
Risk Assessment
Survivors
Time Factors
United States
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https://hdl.handle.net/10161/4366Published Version (Please cite this version)
10.1186/1472-6963-10-256Publication Info
Salz, Talya; Weinberger, Morris; Ayanian, John Z; Brewer, Noel T; Earle, Craig C;
Elston Lafata, Jennifer; ... Sandler, Robert S (2010). Variation in use of surveillance colonoscopy among colorectal cancer survivors in
the United States. BMC Health Serv Res, 10. pp. 256. 10.1186/1472-6963-10-256. Retrieved from https://hdl.handle.net/10161/4366.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Deborah Anne Fisher
Associate Professor of Medicine
1) Clinical interests and focus: I am a general gastroenterologist with a particular
interest in colorectal cancer screening/surveillance and quality improvement. I recently
served on the ASGE Assessment of Quality in Endoscopy committee and currently serve
on the AGA Clinical Practice Updates committee.
2) Research focus: Outcomes, big data, and health services research as applied to
a variety of GI areas including weight-loss devices, NAFLD, colorectal cancer screening,
choled

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