Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States.
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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.
SubjectAttitude of Health Personnel
Continuity of Patient Care
Practice Guidelines as Topic
Published Version (Please cite this version)10.1186/1472-6963-10-256
Publication InfoSalz, 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.
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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