title: Long-term outcomes following positive fecal occult blood test results in older adults: benefits and burdens.
abstract: BACKGROUND
  In the United States, older adults have low rates of follow-up colonoscopy after a positive fecal occult blood test (FOBT) result. The long-term outcomes of these real world practices and their associated benefits and burdens are unknown.
  
  
  METHODS
  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. We 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], 0), average, and worst (age, 70-84 years and CCI, ≥4 or age, ≥85 years and CCI, ≥1).
  
  
  RESULTS
  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) (P = .048 for trend).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Family Medicine, University of North Carolina at Chapel Hill, 27599-7595, USA. Christine_Kistler@med.unc.edu
authors.forename: Christine E
authors.initials: CE
authors.lastname: Kistler
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Kirby
authors.forename: Delia
authors.initials: D
authors.lastname: Lee
authors.forename: Michele A
authors.initials: MA
authors.lastname: Casadei
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
mesh_terms: D000236:Adenoma / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008137:Longitudinal Studies; D008297:Male; D009780:Occult Blood; D017063:Outcome Assessment, Health Care; D016019:Survival Analysis; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data