Authors: Cooper GS, Payes JD
Title: Temporal trends in colorectal procedure use after colorectal cancer resection.
Journal: Gastrointest Endosc 64(6):933-40
Date: 2006 Dec
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.