Nuanced decisions
The findings “may help refine decision-making” about the potential benefits and harms of pursuing or stopping surveillance colonoscopy for older adults who have a history of polyps, Dr. Calderwood and colleagues say.
The risk for a colonoscopy complication has been estimated at 26 per 1,000 people, they note. That’s nearly 10 times greater than the potential benefits seen in their study (that is, identification of CRC in 23 of 9,831 people, or about 2.3 per 1,000).
In the study cohort, 10% of patients had comorbid conditions that have been associated with a higher risk for colonoscopy complications. Those with life expectancy of less than 5 years had higher rates of inadequate bowel preparation, which also is associated with increased risk for colonoscopy complications, including perforation.
Dr. Calderwood and colleagues suggest that clinicians use evidence regarding life expectancy and neoplasia progression to modify their recommendations for surveillance colonoscopy for older adults in the following ways:
- If life expectancy is less than 5 years, recommend against surveillance.
- If life expectancy is 5 to less than 10 years and the patient has only low-risk polyps, recommend against surveillance.
- If the patient is healthy with a life expectancy of 10+ years and has recently been found to have advanced polyps, recommend future surveillance colonoscopy, with a caveat that the ultimate decision is dependent on health and priorities at the time the colonoscopy is due to be performed.
- If future health is unknown or unclear, avoid giving definitive recommendations for future surveillance to allow the flexibility of deciding on the basis of risk and benefit when the time comes.
In comments to this news organization, Dr. Gellad noted that an assessment of patient life expectancy “is not readily accessible at the point of care. These are nuanced decisions that require shared decision-making. Sometimes that is best handled outside the procedure setting.”
Support for the study was provided by the National Cancer Institute. The authors have disclosed no relevant financial relationships. Dr. Gellad is a consultant for Merck and Novo Nordisk and is a cofounder of Higgs Boson.
A version of this article originally appeared on Medscape.com.