Long-term Outcomes Following Positive Fecal Occult Blood Test Results in Older Adults Benefits and Burdens

被引:35
作者
Kistler, Christine E. [1 ]
Kirby, Katharine A. [2 ,3 ]
Lee, Delia [4 ]
Casadei, Michele A. [2 ,3 ]
Walter, Louise C. [2 ,3 ]
机构
[1] Univ N Carolina, Dept Family Med, Chapel Hill, NC 27599 USA
[2] San Francisco VA Med Ctr, Div Geriatr, San Francisco, CA USA
[3] Univ Calif San Francisco, San Francisco, CA 94143 USA
[4] Univ Arkansas, Sch Med, Fayetteville, AR 72701 USA
基金
美国医疗保健研究与质量局;
关键词
COMPLETE DIAGNOSTIC EVALUATION; AMERICAN-CANCER-SOCIETY; COLORECTAL-CANCER; ELDERLY-PATIENTS; COLONOSCOPY SURVEILLANCE; COMORBIDITY INDEX; LIFE EXPECTANCY; UNITED-STATES; GUIDELINES; AGE;
D O I
10.1001/archinternmed.2011.206
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: In the United States, older adults have low rates of follow-up colonoscopy after a positive fecal occult blood test (FOBT) result. The long-term outcomes of these real world practices and their associated benefits and burdens are unknown. Methods: Longitudinal cohort study of 212 patients 70 years or older with a positive FOBT result at 4 Veteran Affairs (VA) facilities in 2001 and followed up through 2008. We determined the frequency of downstream outcomes during the 7 years of follow-up, including procedures, colonoscopic findings, outcomes of treatment, complications, and mortality based on chart review and national VA and Medicare data. Net burden or benefit from screening and follow-up was determined according to each patient's life expectancy. Life expectancy was classified into 3 categories: best (age, 70-79 years and Charlson-Deyo comorbidity index [CCI], 0), average, and worst (age, 70-84 years and CCI, >= 4 or age, >= 85 years and CCI, >= 1). Results: Fifty-six percent of patients received follow-up colonoscopy (118 of 212), which found 34 sig-nificant adenomas and 6 cancers. Ten percent experienced complications from colonoscopy or cancer treatment (12 of 118). Forty-six percent of those without follow-up colonoscopy died of other causes within 5 years of FOBT (43 of 94), while 3 died of colorectal cancer within 5 years. Eighty-seven percent of patients with worst life expectancy experienced a net burden from screening (26 of 30) as did 70% with average life expectancy (92 of 131) and 65% with best life expectancy (35 of 51) (P=.048 for trend). Conclusions: Over a 7-year period, older adults with best life expectancy were less likely to experience a net burden from current screening and follow-up practices than are those with worst life expectancy. The net burden could be decreased by better targeting FOBT screening and follow-up to healthy older adults.
引用
收藏
页码:1344 / 1351
页数:8
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