Many Older Adults Advised to Return for Follow-up Colonoscopy

Most older adults with low-risk colonoscopy findings are told to return for surveillance colonoscopy even when their life expectancy is limited, according to a study published in JAMA Internal Medicine.

The cohort study included 9831 adults older than 65 years from the New Hampshire Colonoscopy Registry who underwent colonoscopy for surveillance after prior colon polyps. Researchers linked data from the registry with Medicare claims data and used a validated prediction model to estimate the life expectancy of patients. Patients had an average age of 73.2, and 53.8% were men.

The likelihood of finding advanced polyps and colorectal cancer in the population was low, according to the study. Just 8% of participants had advanced polyps or colorectal cancer on surveillance colonoscopy.

Nevertheless, 86.9% of patients were advised to return for surveillance colonoscopy, the study found. Among older adults with no polyps or small hyperplastic polyps, 58.1% of those with a life expectancy of less than 5 years were told to return, as were 74.8% with a life expectancy between 5 and 10 years and 95.2% with life expectancy of 10 years or more.

“These findings suggest that recommending against future surveillance colonoscopy in older adults with low-risk colonoscopy findings and/or limited life expectancy should be considered more frequently than is currently practiced,” wrote first author Audrey H. Calderwood, MD, MS, of Dartmouth-Hitchcock Medical Cancer, Lebanon, New Hampshire, and coauthors.

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. 2023;183(5):426-434. doi:10.1001/jamainternmed.2023.0078