Elderly Patients Often Not Up-to-Date on Screening for Colorectal Cancer
Screening for colorectal cancer (CRC) is not widely used by Americans age 75 years and older, even though some patients are healthy and may benefit.1 Furthermore, appropriate follow-up is not occurring in a timely manner for approximately one-third of older adults.
CRC is a disease largely diagnosed in the elderly, with almost 25% of cases occurring in persons age 75 to 84 years. Screening guidelines for CRC vary according to their source. This study focused on consistency with the recommendations of the US Preventive Services Task Force (USPSTF).
"Completion of CRC screening, including follow-up of abnormal tests, among the elderly is an understudied area that is important for patients, clinicians, policymakers, and researchers to consider so that screening resources are directed to those who may benefit most," explained Carrie N. Klabunde, PhD, of the Office of Disease Prevention, National Institutes of Health, Rockville, Maryland, and lead investigator of the study.
The investigators examined medical records from nearly 850,000 patients enrolled in 3 integrated health systems that are part of the Population-Based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium. The patients were age 65 to 89 years and were members of Group Health in Washington state and northern Idaho, Kaiser Permanente Northern California, or Kaiser Permanente Southern California from January 1, 2011, through December 31, 2012.
The researchers examined 2 questions in detail: what proportion of patients were up-to-date with recommended CRC screening, and, for those screened with fecal blood tests, what was the likelihood of receiving a follow-up colonoscopy within 3 months after a positive result? They also examined whether age or the presence of other medical conditions has greater influence on patients' likelihood of undergoing CRC screening or follow-up.
Age was found to have a greater influence on CRC screening in the elderly than comorbidity or the presence of other chronic diseases or conditions.
"This finding is consistent with practice guidelines that emphasize age cut offs in determining who should be screened. The physicians and health systems represented in this study appear to be adhering to age-focused guidelines. However, the lack of tools to assist clinicians and elderly patients in shared decision-making about screening that incorporates the patient's age, health status, preferences, and ability to tolerate screening tests and interventions presents a significant challenge to implementing guidelines that call for more individualized recommendations," noted Klabunde.
The study found that 72% of all those age 65 to 89 years were up-to-date with recommended screening. However, only 65% of those who used fecal blood testing and had a positive result received a follow-up colonoscopy within 3 months.
"There are many opportunities for improvement in screening completion among the elderly. Primary care practices need to develop and integrate systems to support individualized as opposed to age-based decision making, including risk assessment tools that consider age and comorbidity in estimates of benefits and harms. More research is needed to understand facilitators of and barriers to completing CRC screening, including timely follow-up of abnormal tests [results], in the elderly," concluded the authors.
1. Klabunde CN, Zheng Y, Quinn VP, et al. Influence of age and comorbidity on colorectal cancer screening in the elderly. Am J Prev Med. 2016 Jun 22. doi:10.1016/j.amepre.2016.04.018. [Epub ahead of print]