title: Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States.
abstract: BACKGROUND
  Clinical practice guidelines recommend colonoscopies at regular intervals for colorectal cancer (CRC) survivors. Using data from a large, multi-regional, population-based cohort, we describe the rate of surveillance colonoscopy and its association with geographic, sociodemographic, clinical, and health services characteristics.
  
  
  METHODS
  We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Eligible survivors were diagnosed between 2003 and 2005, had curative surgery for CRC, and were alive without recurrences 14 months after surgery with curative intent. Data came from patient interviews and medical record abstraction. We used a multivariate logit model to identify predictors of colonoscopy use.
  
  
  RESULTS
  Despite guidelines recommending surveillance, only 49% of the 1423 eligible survivors received a colonoscopy within 14 months after surgery. We observed large regional differences (38% to 57%) across regions. Survivors who received screening colonoscopy were more likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90); have visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82); and received adjuvant chemotherapy (OR = 1.75, 95% CI: 1.27-2.41). Compared to survivors with no comorbidities, survivors with moderate or severe comorbidities were less likely to receive surveillance colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively).
  
  
  CONCLUSIONS
  Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.
authors.affiliation: Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 E, 63rd St, New York, NY 10065, USA. salzt@mskcc.org
authors.forename: Talya
authors.initials: T
authors.lastname: Salz
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: Jennifer
authors.initials: J
authors.lastname: Elston Lafata
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Weiner
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sandler
mesh_terms: D001291:Attitude of Health Personnel; D003082:Colectomy / Q000379:methods; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000592:standards / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D016017:Odds Ratio; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D017741:Survivors; D013997:Time Factors; D014481:United States
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