276 Low Rates of Colonoscopic Surveillance Among Patients With High Risk Adenomas

Abstract

INTRODUCTION: There have been a myriad of efforts to address suboptimal colorectal cancer (CRC) screening rates in the United States (US). Individuals with high-risk colon polyps detected during screening colonoscopy have 2- to 5-fold increased risk for the future development of CRC; however, there are few efforts directed towards optimizing risk reduction in this group. We examined surveillance uptake for patients with high-risk polyps in a large, academic healthcare system. METHODS: \We identified a cohort of patients: 1) age 50–75; 2) with a colonoscopic diagnosis of high-risk adenoma (HRA; 1 adenoma >1 cm, adenoma with villous histology, adenoma with high-grade dysplasia, or 3 or more adenomas) between January 2013 and January 2016; and 3) regular primary care (PC) at UCLA Health. We collected information from the electronic health record (EHR) on demographics, polyp histology, colonoscopy completion, and office visits. We determined the proportion of patients that completed surveillance colonoscopy each year and used Student's t-tests and chi-square tests to evaluate univariate associations between patient characteristics and colonoscopy completion. RESULTS: Our cohort included 203 individuals with HRA. Mean age was 62.5 (SD = 7.6), 62.6% were male, and 75.3% were White (Table 1). There were 153 (75.4%) patients who did not complete surveillance within 3 years. Surveillance completion increased from 24.6% to 40.4% by 3.5 years. 110 (54.2%) completed surveillance by the end of 5 years (Table 2). In all, 202 (99.5%) patients had documentation of a PC visit and 165 (81.3%) had documentation of a GI visit before surveillance was due. There were 121 (59.6%) patients with a documented history of adenoma in the EHR problem list. Patients with ≥1 GI visit after HRA diagnosis (165, 81.3%) were more likely to complete surveillance than patients without a GI visit after HRA diagnosis (38, 18.7%) (P < 0.001). CONCLUSION: Overall uptake of surveillance colonoscopy was low at 3 years for patients with HRA. There was notable improvement in follow-up by 3.5 years; however, adherence remained suboptimal at 40%. Clinical implications of this delay are unknown. Documentation of adenoma history was low. Individuals with HRA represent a group that has been largely neglected in CRC prevention/control research and that warrants evidence-based strategies to ensure appropriate follow-up to reduce CRC burden.