Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States
1 Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 E. 63rd St., New York, NY 10065, USA
2 Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101d McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC 27599-7411, USA
3 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
4 Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina, 364 Rosenau Hall CB7440, Chapel Hill, NC 27599, USA
5 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
6 Center for Health Services Research, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI 48202, USA
7 Durham VAMC, HSR&D Center of Excellence, Duke University Medical Center, Department of Medicine, 508 Fulton Street, Building #6, Durham NC 27705, USA
8 Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101d McGavran-Greenberg Hall, CB# 7411, Chapel Hill, NC 27599-7411, USA
9 Division of Gastroenterology and Hepatology, CB# 7555, 4157 Bioinformatics Building, University of North Carolina, Chapel Hill, NC 27599-7555, USA
BMC Health Services Research 2010, 10:256 doi:10.1186/1472-6963-10-256Published: 1 September 2010
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.