In the Journals

Time to colonoscopy following positive fecal blood test varies greatly

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February 3, 2016

The time between a positive fecal blood test result and a follow-up colonoscopy varied greatly across four U.S. health care systems, according to study results.

Older patients and those with more comorbidities appeared most likely to not receive a follow-up colonoscopy, Jessica Chubak, PhD, associate investigator at Group Health Research Institute in Seattle, and colleagues found.

Jessica Chubak, PhD

Jessica Chubak, PhD

“Preventing deaths from colorectal cancer is an important public health goal, and screening is a major part of this effort,” Chubak told HemOnc Today. Fecal blood testing is one of the recommended approaches to screening, but for it to be effective, positive fecal blood tests need to be followed up with colonoscopies. We conducted this study to learn about follow-up patterns and to better understand what factors are linked to timing of follow-up.”

The researchers derived data from four U.S. health systems selected to represent a geographically and ethnically diverse study population — Group Health Research Institute in Seattle, Kaiser Permanente Norther California, Kaiser Permanente Southern California, and Parkland Health and Hospital System–University of Texas Southwestern Medical Center.

The analysis included 62,384 patients aged 50 and 89 years who had received a positive fecal blood test in 2011 or 2012. Sixty-one percent of patients were aged younger than 65 years, and 52% were men.

Most patients had their follow-up colonoscopy within 6 months, although the rates varied significantly across the four health systems (P < .001).

The median number of days between the positive test and the colonoscopy ranged from 41 (95% CI, 40-41) among patients from Kaiser Permanente Southern California to 174 (95% CI, 123-343) among patients from Parkland Health.

Likewise, the proportion of patients who followed up with a colonoscopy by 12 months ranged from 58.1% (95% CI, 51.6-63.7) at Parkland Health to 83.8% (95% CI, 83.4-84.3) at Kaiser Permanente Northern California.

Researchers also observed patient-level risk factors.

Older patients appeared to have worse follow-up rates than younger patients. Compared with patients aged 50 to 54 years, follow-up was less common among those aged 70 to 75 years (HR = 0.9; 95% CI, 0.87-0.94), 76 to 84 years (HR = 0.65; 95% CI, 0.61-0.69) and 85 to 89 years (HR = 0.34; 95% CI, 0.29-0.39).

Patients with a Charlson comorbidity score of 3 or higher (HR = 0.7; 95% CI, 0.67-0.72), 2 (HR = 0.87; 95% CI, 0.84-0.9) and 1 (HR = 0.93; 95% CI, 0.91-0.96) also were less likely to undergo follow-up colonoscopy compared with patents with a score of 0.

Researchers acknowledged the study did not determine whether delays in the follow-up colonoscopy affected colorectal cancer mortality rates. However, future research will examine this question, Chubak said.

“Next, [our] consortium hopes to understand whether and how timing of follow-up colonoscopy is related to colorectal cancer outcomes,” she said. “If we can do this, it will be an important next step in the field.”  – by Anthony SanFilippo

For more information:

Jessica Chubak, PhD, can be reached at chubak.j@ghc.org.

Disclosure: The researchers report no relevant financial disclosures.

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