Evaluating the Age Distribution of Patients With Colorectal Cancer: Are the United States Preventative Services Task Force Guidelines for Colorectal Cancer Screening Appropriate?

Shellnut, Jason; Wasvary, Harry; Grodsky, Marc B.; Boura, Judith; Priest, S.

doi:10.1007/dcr.0b013e3181bc01d1

Cited by 22 publications

(18 citation statements)

References 7 publications

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“…We grouped 70-75 year olds together because previous research suggests that for individuals in this age range with a high burden of comorbidity life expectancy is similar and is less than the 10 years needed for benefit from screening. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] We carried out multivariable log binomial regression to identify independent predictors of screening utilization within 24 months of the qualifying 2010 visit and to calculate adjusted screening rates. Robust standard errors were used to adjust for clustering within facility.…”

Section: Discussionmentioning

confidence: 99%

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Role of quality measurement in inappropriate use of screening for colorectal cancer: retrospective cohort study

Saini

Vijan

Schoenfeld

et al. 2014

BMJ

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Objective To examine whether the age based quality measure for screening for colorectal cancer is associated with overuse of screening in patients aged 70-75 in poor health and underuse in those aged over age 75 in good health.Design Retrospective cohort study utilizing electronic data from the Veterans Affairs (VA) Health Care System, the largest integrated healthcare system in the United States.Setting VA Health Care System. Participants Veterans aged ≥50 due for repeat average risk colorectal cancer screening at a primary care visit in fiscal year 2010.Main outcome measures Completion of colonoscopy, sigmoidoscopy, or fecal occult blood testing within 24 months of the 2010 visit.Results 399 067 veterans met inclusion/exclusion criteria (mean age 67, 97% men). Of these, 38% had electronically documented screening within 24 months. In multivariable log binomial regression adjusted for Charlson comorbidity index, sex, and number of primary care visits, screening decreased markedly after the age of 75 (the age cut off used by the quality measure) (adjusted relative risk 0.35, 95% confidence interval 0.30 to 0.40). A veteran who was aged 75 and unhealthy (in whom life expectancy might be limited and screening more likely to result in net burden or harm) was significantly more likely to undergo screening than a veteran aged 76 and healthy (unadjusted relative risk 1.64, 1.36 to 1.97). ConclusionsSpecification of a quality measure can have important implications for clinical care. Future quality measures should focus on individual risk/benefit to ensure that patients who are likely to benefit from a service receive it (regardless of age), and that those who are likely to incur harm are spared unnecessary and costly care. IntroductionQuality measures are metrics used to assess the quality of healthcare. The definitions, or specifications, for quality measures are commonly derived directly from clinical practice guidelines. One example is the Healthcare Effectiveness Data and Information Set (HEDIS) measure, which seeks to decrease underuse of screening for colorectal cancer in the United States. The current HEDIS measure is based on the screening recommendations of the US Preventive Services Task Force (USPSTF) guideline, which suggests routine screening in patients at average risk starting at the age of 50 and continuing through to the age of 75.1 The United Kingdom National Health Service (NHS) has proposed a similar age based measure for the bowel cancer screening program in the UK.2 Large integrated healthcare organizations in the US, such as the Veterans Affairs (VA) Health Care System, have also introduced age based quality measures as part of their accountability and improvement programs; indeed, VA has an active measurement and feedback system in place to encourage screening in age eligible individuals. 3Despite the use of these well established age based quality measures, experts recommend that the decision to screen be informed by estimated life expectancy rather than age alone.

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Section: Discussionmentioning

confidence: 99%

“…Such patients are unlikely to benefit from (and might even be harmed by) screening. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] …”

Section: Outcome and Predictor Variablesmentioning

confidence: 99%

Role of quality measurement in inappropriate use of screening for colorectal cancer: retrospective cohort study

Saini

Vijan

Schoenfeld

et al. 2014

BMJ

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“…What happens to the population outside the screening age group? In an important study, Shellnut et al (2010) looked at the appropriateness of restricting the screened age group and found that not screening individuals under 50 and over 75 years would miss around 49 to 50% of patients in their study. Harmston et al (2010) looked at 100 patients with CRC in the NHSBCSP and analysed their symptoms.…”

Section: Who Screening Principlesmentioning

confidence: 99%

Pathology of Staging of Early Colorectal Lesions During Surveillance Programmes

Salmo¹,

Haboubi²

2011

Colonoscopy

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“…Incidence and death rates for colorectal cancer increases with age. In fact, 90% of new cases and 94% of deaths occur in individuals 50 years and older [4].…”

Section: Introductionmentioning

confidence: 99%

“…Incidence and death rates for colorectal cancer increases with age. In fact, 90% of new cases and 94% of deaths occur in individuals 50 years and older [4].Overall, colorectal cancer incidence and mortality rates are approximately 35-40% higher in men than in women. The reasons for this are not completely understood, but they most likely stem For reprint orders, please contact: reprints@futuremedicine.com…”

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confidence: 98%

Dianthin-EGF is an Effective Tumor Targeted Toxin in Combination with Saponins in a Xenograft Model for Colon Carcinoma

et al. 2014

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Evaluating the Age Distribution of Patients With Colorectal Cancer: Are the United States Preventative Services Task Force Guidelines for Colorectal Cancer Screening Appropriate?

Abstract: There has been a significant increase in the percentage of colorectal cancer patients older than age 75 years. Failing to screen patients younger than 50 years and older than the age of 75 years would miss 49% of patients treated at our institution from 2003 to 2007.

Cited by 22 publications

References 7 publications

Role of quality measurement in inappropriate use of screening for colorectal cancer: retrospective cohort study

Role of quality measurement in inappropriate use of screening for colorectal cancer: retrospective cohort study

Pathology of Staging of Early Colorectal Lesions During Surveillance Programmes

Dianthin-EGF is an Effective Tumor Targeted Toxin in Combination with Saponins in a Xenograft Model for Colon Carcinoma

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