High rates of cancer screening among dialysis patients seen in primary care a cohort study

• Published in: Preventive medicine reports 2018-06, Vol.10, p.176-183
• Main Authors: Thorsteinsdottir, Bjorg, Hickson, LaTonya J, Ramar, Priya, Reinalda, Megan, Krueger, Nicholas W, Crowson, Cynthia S, Rule, Andrew D, Takahashi, Paul Y, Chaudhry, Rajeev, Tulledge-Scheitel, Sidna M, Tilburt, Jon C, Williams, Amy W, Albright, Robert C, Meier, Sarah K, Shah, Nilay D
• Format: Article
• Language: English
• Subjects: Breast cancer screening; Cervical cancer screening; Colon cancer screening; Dialysis; ESRD; Internal Medicine; Preventive screening; Prostate cancer screening; Review
• ISSN: 2211-3355; 2211-3355
• DOI: 10.1016/j.pmedr.2018.03.006

Abstract Routine preventive cancer screening is not recommended for patients with end-stage renal disease (ESRD) due to their limited life expectancy. The current extent of cancer screening in this population is unknown. Primary care (PC) reminder systems or performance incentives may encourage indiscriminate cancer screening. We compared rates of cancer screening in patients with ESRD, with and without PC visits. This is a retrospective cohort study using United States Renal Data System (USRDS) billing data and electronic medical record data. Patients aged ≥18 years starting dialysis from 2001 to 2008, Midwest regional dialysis network were categorized with or without a PC visit (defined as an office visit in family practice, internal medicine, pediatrics, geriatrics or preventive medicine during the first two years of dialysis). Cancer screening was based on Current Procedural Terminology codes in USRDS. We identified 2512 incident dialysis patients (60% men, median age 65y). Cancer screening rates were more frequent among those seen in PC: 38% vs 19% ( P  = 0.0002), for breast; 18% vs 10% ( P  = 0.047) for cervical; 13% versus 8% ( P  = 0.024) for prostate; and 18% vs 9% (P = 0.0002) for colon cancer. Multivariable analyses found that those with PC were more likely to be screened after adjusting for age, sex, and comorbidities. In our practice, cancer screening rates among chronic dialysis patients are lower than those previously reported for our general population (64% for breast cancer). However, a sizeable proportion of our ESRD population does receive cancer screening, especially those still seen in primary care.