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

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Creator
  • Salz, Talya
    • Other Affiliation: Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 E. 63rd St., New York, NY 10065, USA
  • Sandler, Robert
    • Affiliation: School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology
  • Ayanian, John Z
    • Other Affiliation: Division of General Medicine, Brigham and Women’s Hospital; Department of Health Care Policy, Harvard Medical School, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, USA
  • Weinberger, Morris
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • Lafata, Jennifer Elston
    • Other Affiliation: Center for Health Services Research, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI 48202, USA
  • Fisher, Deborah A
    • Other Affiliation: Durham VAMC, HSR&D Center of Excellence, Duke University Medical Center, Department of Medicine, 508 Fulton Street, Building #6, Durham NC 27705, USA
  • Earle, Craig C
    • Other Affiliation: Health Services Research Program, Cancer Care Ontario and the Ontario Institute for Cancer Research, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room G-106 Toronto ON, M4N 3M5, Canada
  • Brewer, Noel T.
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
  • Weiner, Bryan
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • 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.
Date of publication
Identifier
  • doi:10.1186/1472-6963-10-256
  • 20809966
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Talya Salz et al.; licensee BioMed Central Ltd.
License
Journal title
  • BMC Health Services Research
Journal volume
  • 10
Journal issue
  • 1
Page start
  • 256
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1472-6963
Bibliographic citation
  • BMC Health Services Research. 2010 Sep 01;10(1):256
Access
  • Open Access
Publisher
  • BioMed Central Ltd
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