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. 2016 Sep;51(3):e67-75.
doi: 10.1016/j.amepre.2016.04.018. Epub 2016 Jun 22.

Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly

Carrie N Klabunde  1 , Yingye Zheng  2 , Virginia P Quinn  3 , Elisabeth F Beaber  2 , Carolyn M Rutter  4 , Ethan A Halm  5 , Jessica Chubak  6 , Chyke A Doubeni  7 , Jennifer S Haas  8 , Aruna Kamineni  6 , Marilyn M Schapira  9 , Pamela M Vacek  10 , Michael P Garcia  2 , Douglas A Corley  11 ; PROSPR consortium
Affiliations

Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly

Carrie N Klabunde et al. Am J Prev Med. 2016 Sep.

Abstract

Introduction: Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata, among a large cohort of elderly individuals in community settings.

Methods: A population-based, longitudinal cohort study was conducted among health plan members aged 65-89 years enrolled during 2011-2012 in three integrated healthcare systems participating in the Population-Based Research Optimizing Screening through Personalized Regimens consortium. Comorbidity measurements used the Charlson index. Analyses, conducted in 2015, comprised descriptive statistics and multivariable modeling that estimated age by comorbidity-specific percentages of patients for two outcomes: colorectal cancer screening uptake and follow-up of abnormal fecal blood tests.

Results: Among 846,267 patients, 72% were up-to-date with colorectal cancer screening. Of patients with a positive fecal blood test, 65% received follow-up colonoscopy within 3 months. Likelihood of being up-to-date and receiving timely follow-up was significantly lower for patients aged ≥76 years than their younger counterparts (p<0.001). Comorbidity was less influential than age and more strongly related to timely follow-up than being up-to-date. In all age groups, considerable numbers of patients with no/low comorbidity were not up-to-date or did not receive timely follow-up.

Conclusions: In three integrated healthcare systems, many older, relatively healthy patients were not screening up-to-date, and some relatively young, healthy patients did not receive timely follow-up. Findings suggest a need for re-evaluating age-based screening guidelines and improving screening completion among the elderly.

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Figures

Figure 1
Figure 1
Elderly patients’ colorectal cancer screening status A. By age group, adjusted for comorbidity. B. By Charlson comorbidity score, adjusted for age.
Figure 1
Figure 1
Elderly patients’ colorectal cancer screening status A. By age group, adjusted for comorbidity. B. By Charlson comorbidity score, adjusted for age.
Figure 2
Figure 2
Multivariate-adjusted percentages of elderly patients by age group and comorbidity score A. Up-to-date with colorectal cancer screening B. Receiving timely follow-up
Figure 2
Figure 2
Multivariate-adjusted percentages of elderly patients by age group and comorbidity score A. Up-to-date with colorectal cancer screening B. Receiving timely follow-up
See this image and copyright information in PMC

References

    1. U.S. Preventive Services Task Force Screening for colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2008;149(9):627–637. http://dx.doi.org/10.7326/0003-4819-149-9-200811040-00243. - DOI - PubMed
    1. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134(5):1570–1595. http://dx.doi.org/10.1053/j.gastro.2008.02.002. - DOI - PubMed
    1. Qaseem A, Denberg TD, Hopkins RH, et al. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156(5):378–386. http://dx.doi.org/10.7326/0003-4819-156-5-201203060-00010. - DOI - PubMed
    1. American Geriatrics Society Ethics Committee Health screening decisions for older adults: AGS position paper. J Am Geriatr Soc. 2003;51(2):270–271. http://dx.doi.org/10.1046/j.1532-5415.2003.51069.x. - DOI - PubMed
    1. Van Hees F, Habbema JD, Meester RG, Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG. Should colorectal cancer screening be considered in the elderly persons without previous screening? A cost-effectiveness analysis. Ann Intern Med. 2014;160(11):750–759. http://dx.doi.org/10.7326/M13-2263. - DOI - PMC - PubMed

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