Long-term outcomes following positive FOBT results in older adults

January 01, 0001

Long-term outcomes following positive FOBT results in older adults

In the United States, older adults have low rates of follow-up colonoscopy after a positive fecal occult blood test (FOBT) result. These US authors conducted a longitudinal cohort study of 212 patients 70 years or older with a positive FOBT result at 4 Veteran Affairs (VA) facilities in 2001 and followed up through 2008. They determined the frequency of downstream outcomes during the 7 years of follow-up, including procedures, colonoscopic findings, outcomes of treatment, complications, and mortality based on chart review and national VA and Medicare data. Net burden or benefit from screening and follow-up was determined according to each patient's life expectancy. Life expectancy was classified into 3 categories: best (age, 70-79 years and Charlson-Deyo comorbidity index [CCI

They found: "Fifty-six percent of patients received follow-up colonoscopy (118 of 212), which found 34 significant adenomas and 6 cancers. Ten percent experienced complications from colonoscopy or cancer treatment (12 of 118). Forty-six percent of those without follow-up colonoscopy died of other causes within 5 years of FOBT (43 of 94), while 3 died of colorectal cancer within 5 years. Eighty-seven percent of patients with worst life expectancy experienced a net burden from screening (26 of 30) as did 70% with average life expectancy (92 of 131) and 65% with best life expectancy (35 of 51)."

The authors concluded: "Over a 7-year period, older adults with best life expectancy were less likely to experience a net burden from current screening and follow-up practices than are those with worst life expectancy. The net burden could be decreased by better targeting FOBT screening and follow-up to healthy older adults."

Even those with best health had a net burden, so decision- making wit people over 70 should be individualized.

For the full abstract, click here.

Arch Intern Med 171(15):1344-1351, 8/22 August 2011 © 2011 to the American Medical Association
Long-term Outcomes Following Positive Fecal Occult Blood Test Results in Older Adults-Benefits and Burdens. Christine E. Kistler, Katharine A. Kirby, Delia Lee, Michele A. Casadei, Louise C. Walter. Correspondence to Dr. Kistler: [email protected]

Category: D. Digestive. Keywords: fecal occult blood test, older adults, colonoscopy, colon cancer, life expectancy, prospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 6 September 2011

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