Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 1;183(5):426-434.
doi: 10.1001/jamainternmed.2023.0078.

Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults

Audrey H Calderwood  1   2 , Tor D Tosteson  2   3   4 , Qianfei Wang  2 , Tracy Onega  5 , Louise C Walter  6   7
Affiliations

Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults

Audrey H Calderwood et al. JAMA Intern Med. .

Abstract

Importance: Surveillance after prior colon polyps is the most frequent indication for colonoscopy in older adults. However, to our knowledge, the current use of surveillance colonoscopy, clinical outcomes, and follow-up recommendations in association with life expectancy, factoring in both age and comorbidities, have not been studied.

Objective: To evaluate the association of estimated life expectancy with surveillance colonoscopy findings and follow-up recommendations among older adults.

Design, setting, and participants: This registry-based cohort study used data from the New Hampshire Colonoscopy Registry (NHCR) linked with Medicare claims data and included adults in the NHCR who were older than 65 years, underwent colonoscopy for surveillance after prior polyps between April 1, 2009, and December 31, 2018, and had full Medicare Parts A and B coverage and no Medicare managed care plan enrollment in the year prior to colonoscopy. Data were analyzed from December 2019 to March 2021.

Exposures: Life expectancy (<5 years, 5 to <10 years, or ≥10 years), estimated using a validated prediction model.

Main outcomes and measures: The main outcomes were clinical findings of colon polyps or colorectal cancer (CRC) and recommendations for future colonoscopy.

Results: Among 9831 adults included in the study, the mean (SD) age was 73.2 (5.0) years and 5285 (53.8%) were male. A total of 5649 patients (57.5%) had an estimated life expectancy of 10 or more years, 3443 (35.0%) of 5 to less than 10 years, and 739 (7.5%) of less than 5 years. Overall, 791 patients (8.0%) had advanced polyps (768 [7.8%]) or CRC (23 [0.2%]). Among the 5281 patients with available recommendations (53.7%), 4588 (86.9%) were recommended to return for future colonoscopy. Those with longer life expectancy or more advanced clinical findings were more likely to be told to return. For example, among patients with no polyps or only small hyperplastic polyps, 132 of 227 (58.1%) with life expectancy of less than 5 years were told to return for future surveillance colonoscopy vs 940 of 1257 (74.8%) with life expectancy of 5 to less than 10 years and 2163 of 2272 (95.2%) with life expectancy of 10 years or more (P < .001).

Conclusions and relevance: In this cohort study, the likelihood of finding advanced polyps and CRC on surveillance colonoscopy was low regardless of life expectancy. Despite this observation, 58.1% of older adults with less than 5 years' life expectancy were recommended to return for future surveillance colonoscopy. These data may help refine decision-making about pursuing or stopping surveillance colonoscopy in older adults with a history of polyps.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Calderwood reported receiving grants from the Dartmouth-Hitchcock Cancer Research Fellows Program, the Dartmouth Cancer Center Support Grant from the National Cancer Institute (NCI), and the Dartmouth Clinical and Translational Science Institute award from the National Center for Advancing Translational Sciences. Dr Onega reported receiving grants from the NIH during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Adults Older Than 65 Years Undergoing Colonoscopy for Polyp Surveillance in New Hampshire From 2009 to 2018
NHCR indicates New Hampshire Colonoscopy Registry.
Figure 2.
Figure 2.. Distribution of Life Expectancy Among 9831 Patients Undergoing Surveillance Colonoscopy
Figure 3.
Figure 3.. Percentage of Adults With Recommendations to Continue Colonoscopy Surveillance Based on Most Recent Colonoscopy Findings and Estimated Life Expectancy Among 5281 Adults Older Than 65 Years With an Available Recommendation to Continue or Stop Surveillance
CRC indicates colorectal cancer. aP < .001 for trend. bP = .002 for trend. cData censored due to Medicare restrictions on reporting.
See this image and copyright information in PMC

References

    1. Lieberman DA, Williams JL, Holub JL, et al. . Colonoscopy utilization and outcomes 2000 to 2011. Gastrointest Endosc. 2014;80(1):133-143. doi:10.1016/j.gie.2014.01.014 - DOI - PubMed
    1. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143(3):844-857. doi:10.1053/j.gastro.2012.06.001 - DOI - PubMed
    1. Calderwood AH, Holub JL, Greenwald DA, Robertson DJ. Yield and practice patterns of surveillance colonoscopy among older adults: an analysis of the GI Quality Improvement Consortium. Am J Gastroenterol. 2019;114(11):1811-1819. doi:10.14309/ajg.0000000000000430 - DOI - PubMed
    1. Calderwood AH, Tosteson TD, Walter LC, Hua P, Onega T. Colonoscopy utilization and outcomes in older adults: data from the New Hampshire Colonoscopy Registry. J Am Geriatr Soc. 2022;70(3):801-811. doi:10.1111/jgs.17560 - DOI - PMC - PubMed
    1. Cooper GS, Kou TD, Barnholtz Sloan JS, Koroukian SM, Schluchter MD. Use of colonoscopy for polyp surveillance in Medicare beneficiaries. Cancer. 2013;119(10):1800-1807. doi:10.1002/cncr.27990 - DOI - PMC - PubMed

Publication types