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

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

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dc.contributor.author Salz, Talya
dc.contributor.author Weinberger, Morris
dc.contributor.author Brewer, Noel T
dc.contributor.author Earle, Craig C
dc.contributor.author Elston Lafata, Jennifer
dc.contributor.author Fisher, Deborah A
dc.contributor.author Weiner, Bryan J
dc.contributor.author Sandler, Robert S
dc.contributor.author Ayanian, John Zaven
dc.date.accessioned 2011-05-09T23:57:27Z
dc.date.issued 2010
dc.identifier.citation Salz, Talya, Morris Weinberger, John Z. Ayanian, Noel T. Brewer, Craig C. Earle, Jennifer Elston Lafata, Deborah A. Fisher, Bryan J. Weiner, and Robert S. Sandler. 2010. Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States. BMC Health Services Research 10: 256. en_US
dc.identifier.issn 1472-6963 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:4885942
dc.description.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. en_US
dc.language.iso en_US en_US
dc.publisher BioMed Central en_US
dc.relation.isversionof doi:10.1186/1472-6963-10-256 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941495/pdf/ en_US
dash.license LAA
dc.title Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal BMC Health Services Research en_US
dash.depositing.author Ayanian, John Zaven
dc.date.available 2011-05-09T23:57:27Z
dash.affiliation.other SPH^Health Policy and Management en_US
dash.affiliation.other HMS^Medicine-Brigham and Women's Hospital en_US
dash.affiliation.other HMS^Health Care Policy en_US

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