Use of colonoscopy for polyp surveillance in Medicare beneficiaries

Authors

  • Gregory S. Cooper MD,

    Corresponding author
    1. Division of Gastroenterology, University Hospitals Case Medical Center, Case Western Reserve University and Case Comprehensive Cancer Center, Cleveland, Ohio
    • Division of Gastroenterology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5066

    Search for more papers by this author
    • Fax: (216) 983-0347

  • Tzuyung D. Kou PhD,

    1. Division of Gastroenterology, University Hospitals Case Medical Center and Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
    Search for more papers by this author
  • Jill S. Barnholtz Sloan PhD,

    1. Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
    Search for more papers by this author
  • Siran M. Koroukian PhD,

    1. Department of Epidemiology and Biostatistics, and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
    Search for more papers by this author
  • Mark D. Schluchter PhD

    1. Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
    Search for more papers by this author

  • The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used in this study. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development, and Information, Centers for Medicare and Medicaid Services; Information Management Services, Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database.

Abstract

BACKGROUND:

Professional society guidelines recommend follow-up colonoscopy for patients with resected colonic adenomas. However, adherence to guideline recommendations in routine clinical practice has not been well characterized.

METHODS:

The authors used a population-based sample of Medicare beneficiaries to identify all patients aged ≥70 years who had a claim for colonoscopy with polypectomy or hot biopsy during the period from 2001 to 2004. Medicare claims through 2009 identified colonoscopy within the following 5 years as well as fecal occult blood testing, sigmoidoscopy, and barium enema.

RESULTS:

In total, 12,771 patients were included. At 5 years, 45.7% of patients underwent another colonoscopy, and 32.3% of procedures included a polypectomy. The rates of fecal occult blood testing, flexible sigmoidoscopy, and barium enema at 5 years were 54%, 3.8%, and 2.9%, respectively. There was a marked decrease in repeat colonoscopy at 1 year, 3 years, and 5 years with more recent years of index procedures. Other predictors of undergoing repeat colonoscopy were younger age, African American race, and a colonoscopy before the index examination. There was no association with physician specialty. The decreasing use of colonoscopy with time was maintained in a multivariable analysis.

CONCLUSIONS:

In a sample of elderly Medicare beneficiaries, there was under use of follow-up colonoscopy at 5 years after polypectomy, and <50% of patients received a repeat examination. In particular, the use of this procedure decreased over the 4-year study period. Coupled with other data indicating the overuse of follow-up colonoscopy in patients without polyps, there appeared to be significant discordance between guidelines and actual practice. Cancer 2013. © 2013 American Cancer Society.

Ancillary