Little Follow-up After Positive Test for Colon Cancer

A new study has found that more than 40% of patients who received a positive result on a fecal occult blood test (FOBT) did not receive appropriate diagnostic follow-up tests such as a colonoscopy or barium enema.

Researchers at the University of California, Los Angeles (UCLA, USA), and the U.S. Department of Veteran's Affairs (VA, Washington, DC) analyzed the records of 39,870 veteran patients. Of these, 61% of eligible VA patients had been screened for colorectal cancer, which is significantly higher than the U.S. national average. Out of those screened, 313 patients had an abnormal FOBT result. However, only 59% (185) of these patients received follow-up diagnostic tests such as a colonoscopy or a barium enema. The remaining 41% (128) of these patients received no follow-up at all in the six months following the FOBT.

The researchers noted several reasons why patients did not receive any follow-up. Some did not have a primary care visit with a doctor in the six months following the screening, and the others, while they saw a doctor during the six months, were not referred for a follow-up colonoscopy. Potential solutions include educating patients to advocate for screening and follow-up and using electronic systems to track follow-up. The findings were published in the May 2006 edition of Diseases of the Colon & Rectum.

"Traditionally, quality-of-care assessments just look at initial screening rates for colon cancer, but this study reveals that efforts should focus on the entire diagnostic process to help ensure that patients don't slip through the cracks in the system,” said Dr. David A. Etzioni, principal investigator and a clinical scholar in the division of general surgery at the David Geffen School of Medicine at UCLA.



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