Study Suggests Many Healthy Older Veterans Not Being Screened for Colorectal Cancer
KEY FINDINGS:
- Many healthy older Veterans with substantial life expectancies are not being screened, while some with severe comorbidity are being screened. For example, only 47% of Veterans aged >70 without comorbidity were screened despite having a high probability of living >5 years.
- Number of outpatient visits was a strong predictor of screening, independent of comorbidity. Veterans without comorbidity who did not attend a VA primary care, gastroenterology, or general surgery clinic had a lower incidence of screening than patients with severe comorbidity who visited these clinics.
BACKGROUND:
Colorectal cancer (CRC) screening guidelines recommend screening older adults who have substantial life expectancies according to age and/or comorbid conditions. For example, VA, the American Cancer Society, and the American Geriatrics Society recommend CRC screening for older adults unless they are unlikely to live five years or have significant comorbidity that would preclude treatment. Persons with a life expectancy of <5 years are not likely to benefit from screening but remain at risk for harms that might occur, e.g., complications from procedures. This study examined VA and Medicare claims data for 27,068 Veterans >70 years, who were seen at four geographically diverse VA facilities during 2001 and 2002 and were due for CRC screening. Investigators stratified patients by comorbidity, ranging from no comorbidity to severe comorbidity, and assessed five-year mortality.
LIMITATIONS:
- Claims data do not give reasons why a test was ordered or the purpose of a medical visit, so some tests may have been performed for non-screening reasons.
- Some CRC screening tests performed outside of VA may have been missed.
- While the comorbidity index used in this study is a strong predictor of 5-year mortality, it does not include all factors that may determine life expectancy (i.e., functional status).
NOTE:
- These results are based on VA data that was collected in 2001 and 2002. VA recently launched several nationwide initiatives to improve CRC screening. Multiple aspects of colon cancer care are being monitored, and the degree of adherence to accepted quality measures is being assessed. (Chao H, Schwartz A, Hersh J, et al. Improving colorectal cancer screening and care in the Veterans Affairs Healthcare System. Clinical Colorectal Cancer January 2009;8(1):22-28.)
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D. Drs. Walter and Lee, and Ms. Lindquist and Ms. Casadei are part of the San Francisco VAMC; Dr. Partin, Ms. Schult, and Mr. Nugent are part of HSR&D’s Center for Chronic Disease Outcomes Research in Minneapolis.
Walter L, Lindquist K, Nugent S, Schult T, Lee S, Casadei M, Partin M. Impact of Age and Comorbidity on Colorectal Cancer Screening Among Older Veterans. Annals of Internal Medicine 2009 Apr 7;150(7):465-73.
