Avoid future surveillance colonoscopies in low risk elderly with less life expectancy: JAMA

"Still, 58.1% of older adults with less than five years of life expectancy were recommended to return for future surveillance colonoscopy," the researchers stated. "The findings may be useful for decision-making about stopping or pursuing surveillance colonoscopy in older adults with a history of polyps."

In older adults, surveillance after prior colon polyps is the most common indication for colonoscopy. However, the current use of clinical outcomes, surveillance colonoscopy, and follow-up recommendations linked with factoring in age and comorbidities, and life expectancy have yet to be studied well. Considering this, Audrey H. Calderwood, Dartmouth-Hitchcock Medical Cancer, Lebanon, New Hampshire, and colleagues aimed to assess the association of estimated life expectancy with findings of surveillance colonoscopy and follow-up recommendations in older adults in a registry-based cohort study.

For this purpose, the researchers used data from the NHCR (New Hampshire Colonoscopy Registry) linked with Medicare claims data. The study included adults in the NHCR who underwent colonoscopy for surveillance after prior polyps, were older than 65, had complete Medicare Parts A and B coverage, and had no enrollment in the Medicare managed care plan the year before the colonoscopy.

Life expectancy (≥ ten years, 5 to <10 years, or <5 years) was estimated using a validated prediction model. The study's primary outcomes were clinical findings of colon polyps or colorectal cancer and recommendations for future colonoscopy.

The study led to the following findings:

• Among 9831 included adults, the mean age was 73.2 years, and 53.8% were male.
• 57.5% of patients had an estimated life expectancy of 10 or more years, 35.0% of 5 to less than ten years, and 7.5% of fewer than five years.
• 8.0% of patients had advanced polyps (7.8%) or colorectal cancer (0.2%).
• Among the 53.7% of patients with available recommendations, 86.9% were recommended to return for future colonoscopy.
• People with longer life expectancy or more advanced clinical findings could be told to return. For example, among patients with no polyps or only small hyperplastic polyps, 58.1% with a life expectancy of fewer than five years were told to return for future surveillance colonoscopy vs 74.8% with a life expectancy of 5 to less than ten years and 95.2% with a life expectancy of 10 years or more.

"Our findings suggest that recommending against future surveillance colonoscopy in older adults with low-risk colonoscopy findings and limited life expectancy should be considered more frequently than is currently practised," the researchers concluded.

Reference:

Calderwood AH, Tosteson TD, Wang Q, Onega T, Walter LC. Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults. JAMA Intern Med. Published online March 13, 2023. doi:10.1001/jamainternmed.2023.0078