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Smarter colorectal screening could improve senior health

Date:
February 27, 2014
Source:
University of Michigan Health System
Summary:
Age-based colorectal cancer screening guidelines could lead to inappropriate use and contribute to healthy seniors missing out on the preventative tests including colonoscopy. Large health system, Medicare and many private insurers use quality measures to encourage screening among 50- to 75-year-olds. An unhealthy, 75-year-old -- whose life expectancy is estimated at less than five years -- was significantly more likely to undergo screening than a 76-year-old who's in good health, the study found. The study suggests the upper age cut-off could unintentionally discourage screening for these healthy, older individuals, leading them to miss out on the colorectal screenings known to prevent cancer.

Screening for colorectal cancer based on age alone may contribute to both underuse and overuse of the tests among older patients, according to a study by investigators at the University of Michigan and the Veterans Affairs Center for Clinical Management Research.

VA, the nation's largest integrated health system, Medicare and many private insurers use quality measures to encourage screening among 50- to 75-year-olds.

But the use of simple age cut-offs in these quality measures may contribute to what researchers found was underuse of screening in healthy, older people and overuse in unhealthy, older people, according to the study using 2010 data on 399,067 VA enrollees.

An unhealthy, 75-year-old -- whose life expectancy is estimated at less than five years -- was significantly more likely to undergo screening than a 76-year-old who's in good health, according to the study published in BMJ.

"The way quality measures are defined has important implications for how care is delivered," says lead study author Sameer Saini, M.D., a research scientist at VA-CCMR and assistant professor of internal medicine at the U-M Health System. "By focusing on age alone we're not screening everyone who's likely to benefit and some people who are not likely to benefit are being screened unnecessarily, like those with severe health problems.

"If quality measures focused on age and health status, rather than age alone, we'd have better outcomes," he adds.

In elderly patients, life expectancy varies considerably according to health status. For instance, a 74-year-old man who is in excellent health has a life expectancy of almost 15 years.

The study suggests the upper age cut-off could unintentionally discourage screening for these healthy, older individuals, leading them to miss out on the colorectal screenings known to prevent cancer. CRC screening tests include colonoscopy, sigmoidoscopy, and fecal occult blood testing.

"Future patient-centered quality measures should focus on clinical benefit rather than age to ensure that patients who are likely to benefit from screening receive it, regardless of age, and that those who are likely to incur harm are spared unnecessary and costly care," says senior study author Eve Kerr, M.D., M.P.H., director of VA-CCMR and professor of internal medicine at the U-M Health System.


Story Source:

The above story is based on materials provided by University of Michigan Health System. Note: Materials may be edited for content and length.


Journal Reference:

  1. S. D. Saini, S. Vijan, P. Schoenfeld, A. A. Powell, S. Moser, E. A. Kerr. Role of quality measurement in inappropriate use of screening for colorectal cancer: retrospective cohort study. BMJ, 2014; 348 (feb26 2): g1247 DOI: 10.1136/bmj.g1247

Cite This Page:

University of Michigan Health System. "Smarter colorectal screening could improve senior health." ScienceDaily. ScienceDaily, 27 February 2014. <www.sciencedaily.com/releases/2014/02/140227091242.htm>.
University of Michigan Health System. (2014, February 27). Smarter colorectal screening could improve senior health. ScienceDaily. Retrieved September 19, 2014 from www.sciencedaily.com/releases/2014/02/140227091242.htm
University of Michigan Health System. "Smarter colorectal screening could improve senior health." ScienceDaily. www.sciencedaily.com/releases/2014/02/140227091242.htm (accessed September 19, 2014).

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