Colonoscopies often recommended to patients with limited life expectancy
A study of patients ages 65 years and older found that 58.1% of those with life expectancy of less than five years and no polyps or only small hyperplastic polyps were told to return for future surveillance, as were 74.8% of those with life expectancy of five to 10 years.
Older adults with low-risk colonoscopy findings and limited life expectancy are still usually advised to return for additional surveillance, a study found.
To evaluate the association of estimated life expectancy with surveillance colonoscopy findings and follow-up recommendations among older adults, researchers conducted a registry-based cohort study using from the New Hampshire Colonoscopy Registry and Medicare claims data, including 9,831 adults who were older than age 65 years, underwent colonoscopy for surveillance after prior polyps between April 1, 2009, and December 31, 2018, and had full Medicare Parts A and B coverage and no Medicare managed care plan enrollment in the year before colonoscopy. Data were analyzed from December 2019 to March 2021. Results were published by JAMA Internal Medicine on March 13.
A total of 5,649 patients (57.5%) had an estimated life expectancy of 10 or more years, 3,443 (35.0%) of five to less than 10 years, and 739 (7.5%) of less than five years. Overall, 791 patients (8.0%) were found to have advanced polyps (7.8%) or colorectal cancer (0.2%). Among the 5,281 patients with available recommendations (53.7%), 86.9% were recommended to return for future colonoscopy.
Although those with longer life expectancy or more advanced clinical findings were more likely to be told to return, most of those with low life expectancy were also advised to undergo additional surveillance. For example, among patients with no polyps or only small hyperplastic polyps, 58.1% of those with life expectancy of less than five years were told to return for future surveillance colonoscopy compared to 74.8% with life expectancy of five to 10 years and 95.2% with life expectancy of 10 years or more (P<0.001).
The study authors offered their advice on appropriate recommendations. “Clinicians could use evidence regarding life expectancy and neoplasia progression to modify their recommendations for surveillance colonoscopy in older adults in the following ways: (1) if life expectancy is less than 5 years, recommend against surveillance; (2) if life expectancy is 5 to less than 10 years and the patient has only low-risk polyps, recommend against surveillance; (3) if the patient is healthy with a life expectancy of 10 or more years and has recent advanced polyps, provide a recommendation for future surveillance colonoscopy with a caveat that the ultimate decision is dependent on health and priorities at the time the colonoscopy is due; and (4) if future health is unknown or unclear, avoid giving definitive recommendations for future surveillance to allow the flexibility of deciding based on risk and benefit when the time comes.”