Chronic Physical and Mental Comorbidities Decrease Colonoscopy Uptake After Positive Fecal Blood Test
Douglas K. Rex, MD, MASGE, reviewing Bhatia D, et al. Am J Gastroenterol 2022 Mar 23.
This study evaluated 168,701 individuals with a positive fecal occult blood test (FOBT) result, of whom 80.5% underwent colonoscopy within 12 months. Compared with patients not having the same condition, colonoscopy uptake was reduced by 29% in patients with renal failure, 23% in patients with heart failure, and 12% in patients with serious mental illness. The number of medical conditions was also associated with lower colonoscopy uptake. For example, compared with patients with no medical comorbidities, colonoscopy uptake was 36% lower in patients with 4 or more conditions, 25% lower with 3 conditions, and 13% lower with 2 conditions.
COMMENTAlthough this study used a 12-month window to study colonoscopy uptake after a positive FOBT, in clinical practice, there is increasing evidence that patients with positive stool blood tests should undergo colonoscopy within a couple of months of the test. In patients with comorbidities and limited life expectancy, there is always the issue of whether colorectal cancer screening should have been done in the first place. For patients with comorbidities (either significant physical or mental illness) and reasonable life expectancy, these data indicate (as have prior studies) that special efforts should be considered to ensure these patients proceed with colonoscopy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Bhatia D, Sutradhar R, Paszat LF, et al. Effect of chronic comorbidities on follow-up colonoscopy after positive colorectal cancer screening results: a population-based cohort study. Am J Gastroenterol 2022 Mar 23. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000001742)
