Patients not receiving follow-up tests after positive screening for colon cancer

	Tweet

A UCLA/Veteran’s Affairs study showed that more than 40 percent of patients who initially had received a positive result on a fecal occult blood test (FOBT) - an initial screening tool for colon cancer - did not receive appropriate diagnostic follow-up tests such as a colonoscopy or barium enema in 2002.

According to the authors, the study may even underestimate this problem in the United States, since previous studies have shown the VA’s level of preventive care and follow-up traditionally has been higher than at most other health care settings.

Published in May in the journal Diseases of the Colon & Rectum, the UCLA/VA study is one of the largest reviews of colorectal screening and follow-up patient data to date. The study used data from the VA, the nation’s largest integrated health care system. The study was performed as a prelude to a national VA effort, now underway, to improve colorectal cancer screening and suggested the need for better medical follow-through for patients with potential colon cancer.

Study authors took advantage of the VA’s ongoing quality improvement program to analyze 39,870 patient records. Overall, 61 percent of eligible VA patients had been screened for colorectal cancer, a rate significantly higher than the national average. Of the screened population, 313 patients had an abnormal FOBT result. Only 59 percent, or 185 patients, of this group received follow-up diagnostic tests such as a colonoscopy or a barium enema. Forty-one percent, or 128 patients, received no follow-up at all in the six months following the FOBT.

“As a nation, we are getting better in providing colorectal cancer screening, but we need to do a much better job in following-up with diagnostic tests for those patients who have abnormal screening results,” said Dr. David A. Etzioni, principal investigator and a Robert Wood Johnson Clinical Scholar in the Division of General Surgery at the David Geffen School of Medicine at UCLA.

The authors believe that the study has implications for how health care systems monitor their own quality. “Any healthcare system that provides cancer screening programs needs to track each step in the screening process,” Etzioni said. “Many patients were not offered any kind of total colon examination after having a positive screening for colon cancer. Traditionally, quality-of-care assessments just look at initial screening rates for colon cancer, but this study reveals that efforts should focus on the entire diagnostic process to help ensure that patients don’t slip through cracks in the system.”

In the study, researchers identified several possible factors why patients didn’t receive follow-up tests. Fifteen percent of the patients who did not receive follow-up did not have a primary care visit in the six months after the positive FOBT screening. The remaining patients in this group saw a primary care physician but were not referred for a follow-up colonoscopy. For those who did receive follow-up tests, there was a long period between having a positive FOBT to receiving a colonoscopy (250 days) or barium enema (120 days).

“These findings have helped the VA identify key issues to spur more timely follow-up testing, and other systems around the country might do the same” Etzioni said.

Potential solutions include educating patients to advocate for screening and follow-up, and putting electronic systems in place to track follow-up.

http://www.ucla.edu

RELATED STORIES:
Calcium May Only Protect Against Colorectal Cancer in Presence of Magnesium   Researchers Find Possible Link Between Bacterium and Colon Cancer   Program Identifies Families at High Risk for Colorectal Cancer   Balancing oxaliplatin dose with neurological side effects in metastatic colon cancer   Cigarette smoking increases colorectal cancer risk   Sugar + Fat Might Add up to Colon Cancer   Predictors and patterns of recurrence after definitive chemoradiation for anal cancer   Saturated Fat Linked to Cancer of the Small Intestine   HBV infection decreases risk of liver metastasis in colorectal cancer patients   Smoking-related colorectal cancer in older women is associated with molecularly-defined DNA changes   Chemicals in curry and onions may help prevent colon cancer   Hormone replacement tied to lower colon cancer risk   Biomarker Predicts Disease Recurrence in Colorectal Cancer   Women require less tobacco exposure than men to increase colon cancer risk   Healthy life could prevent 23 percent of colon cancers   Cocoa could prevent intestinal pathologies such as colon cancer   Daily drinking may raise risk of several cancers   Western and Japanese diets up colon cancer risk   Low-dose aspirin lowers colon cancer risk: study   Following lifestyle tips could prevent almost a quarter of bowel cancer cases   Sibling Study Could Lead to Better Treatments for Inherited Form of Colon Cancer   Lower socioeconomic status decreases chances of early detection and survival of colorectal cancer

Comments

[ + Post Your Own ]

Now you're in the public comment zone. What follows is not Armenian Medical Network's stuff; it comes from other people and we don't vouch for it. A reminder: By using this Web site you agree to accept our Terms of Service. Click here to read the Rules of Engagement.

There are no comments for this entry yet. [ + Comment here + ]