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Gastrointest Endosc. 2006 Dec;64(6):933-40.

Temporal trends in colorectal procedure use after colorectal cancer resection.

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1
Division of Gastroenterology, University Hospitals of Cleveland and the Department of Epidemiology and Biostatistics and the Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA.

Abstract

BACKGROUND:

After curative cancer resection, routine colon surveillance is recommended. It is not known whether trends over time in cancer survivors parallel that of the general population.

OBJECTIVE:

Our purpose was to describe temporal changes in the use of posttreatment procedures.

DESIGN:

Retrospective cohort study.

SETTING:

Linked tumor registry and Medicare claims data.

PATIENTS:

Medicare beneficiaries >65 years old who were diagnosed with local or regional stage colorectal cancer from 1992-2002 and who underwent surgical resection.

MAIN OUTCOME MEASUREMENTS:

Use of colonoscopy, sigmoidoscopy, or barium enema within 1 year, 18 months, or 3 years of diagnosis.

RESULTS:

A total of 62,882 patients were followed up for 1 year and 35,784 for 3 years. Colonoscopy within 1 year was performed in 25.9%, within 18 months in 53.8%, and within 3 years in 70.3%. Corresponding rates for sigmoidoscopy were 7.4%, 10.2%, and 14.9%, respectively, and were 3.4%, 5.1%, and 7.9%, respectively, for barium enema. There was a decrease over time in the receipt of colonoscopy within 1 year of diagnosis (31.3% in 1992 to 20.6% in 2002), no change in 18-month rates, and a smaller increase in colonoscopy use within 3 years (66.5% to 72.3%). The use of sigmoidoscopy and barium enema declined over time. Overall procedure use within 1 year and 18 months also decreased and 3-year rates were essentially unchanged. These differences were maintained in multivariate analyses.

LIMITATIONS:

Accuracy of procedure coding and indications for tests could not be measured.

CONCLUSIONS:

Temporal trends in procedure use in cancer survivors were consistent with the general population. Importantly, despite guideline recommendations and Medicare reimbursement, 25% of patients who undergo curative treatment do not receive surveillance examinations and this was unchanged over time.

PMID:
17140901
DOI:
10.1016/j.gie.2006.08.024
[Indexed for MEDLINE]
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