Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States

• Published in: BMC health services research 2010-09, Vol.10 (1), p.256-256, Article 256
• Main Authors: Salz, Talya, Weinberger, Morris, Ayanian, John Z, Brewer, Noel T, Earle, Craig C, Elston Lafata, Jennifer, Fisher, Deborah A, Weiner, Bryan J, Sandler, Robert S
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Cancer research; Cancer therapies; Clinical medicine; Colectomy - methods; Colon cancer; Colonoscopy; Colonoscopy - methods; Colonoscopy - statistics & numerical data; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - surgery; Comorbidity; Confidence Intervals; Continuity of Patient Care - standards; Continuity of Patient Care - trends; Data collection; Diagnosis; Ethnicity; Evaluation; Expected values; Female; Follow-Up Studies; Guideline Adherence; Health care access; Health care policy; Health sciences; Health services; Health surveillance; Hepatology; Hospitals; Humans; Incidence; Male; Marital status; Medical records; Medical research; Medical screening; Monitoring, Physiologic - methods; Mortality; Odds Ratio; Patient Compliance; Practice guidelines (Medicine); Practice Guidelines as Topic; Prognosis; Public health; Risk Assessment; Studies; Surgeons; Surgery; Surveillance; Survivors; Task forces; Time Factors; United States; Variables
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-10-256

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. 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. 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). 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.