2016 Issues   /   June 2016

VA Patients Receive Appropriate Scans for CRC

USM By U.S. Medicine
June 2, 2016

INDIANAPOLIS — The current standard for post-treatment surveillance of colorectal cancer (CRC) survivors following curative treatment at the VA is an annual computed tomography scan for three years.

But how often is that guideline followed?

In a study presented at the 2016 Gastrointestinal Cancers Symposium in San Francisco, researchers from the Roudebush VAMC and colleagues conducted a retrospective study to assess the patient, physician and organizational characteristics associated with quality of CT surveillance at VA facilities.1

The study team used the VA’s Central Cancer Registry to identify patients with Stage I-III CRC between 2001 and 2009. Measurements included patient age, race, marital status, income, priority status, year of diagnosis, stage and comorbidity, as well as provider type and facility.

In the primary analysis, researchers looked at the effect of 2005 American Society of Clinical Oncology (ASCO) update in CRC surveillance guidelines. For the secondary analysis, however, only patients diagnosed after 2005 were included, to avoid any bias due to change in guidelines.

Imaging overuse was defined as more than one CT every 12 months, while underuse (UU) was defined as less than one CT every 12 months.

Results indicated that the 2005 guideline update had no effect on how often patients received scans, “as there was an increasing trend favoring more CT scans in general.”

With 2,263 patients in the secondary analysis, underuse of CT occurred in 19.44% of patients, compared with overuse in 15%.

Younger age and higher stage were associated with overuse, while older age and lower stage, as well as facility region, were associated with underuse.

“While present, there did not appear to be substantial rates of UU or OU among CRC survivors in the VA,” the researchers concluded. “Age and cancer stage were associated with the quality of CT surveillance.”

1 Journal of Clinical Oncology, 2016 Gastrointestinal Cancers Symposium (January 21-23, 2016). Vol 34, No 4_suppl (February 1 Supplement), 2016: 525


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