Survey: Too many MDs recommend colon cancer screenings for terminal patients

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A survey of colorectal cancer (CRC) screening patterns among primary care physicians (PCPs) has shown that a large proportion would recommend screening for patients with advanced cancer who do not stand to benefit, according to results published online June 1 in the Journal of General Internal Medicine.

U.S. Preventive Services Task Force guidelines recommend against screening patients with a limited life expectancy, such as populations with unresectable non-small cell lung cancer (NSCLC), according to authors David A. Haggstrom, MD, MAS, of the department of medicine at Indiana University School of Medicine in Indianapolis, and colleagues.

“Nonetheless, 25 percent of PCPs still recommended CRC screening for an 80-year-old patient with unresectable NSCLC,” wrote Haggstrom et al.

Since the majority of cancer screening tests are initiated within PCP offices, the study featured a cross-sectional, nationally representative survey of 1,266 PCPs, including general internal medicine, family practice and obstetrics-gynecology physicians.

The survey featured a number of clinical vignettes which asked PCPs about screening recommendations for patients of varying ages and comorbidities, including NSCLC and ischemic cardiomyopathy.

Results showed that among patients aged 50 and 65, physicians were very likely to recommend CRC screening for healthy patients and those with ischemic cardiomyopathy, with rates ranging from 97 to 100 percent in these groups. There were large differences in recommendations for patients aged 80, however, with healthy patients recommended for screening 90 percent of the time while patients with ischemic cardiomyopathy recommended by 71 percent of PCPs.

In all age groups, there was a significant drop in CRC screening recommendations for patients with unresectable NSCLC, but a sizable portion of PCPs still recommended screening, according to the authors. PCPs would recommend NSCLC patients aged 50, 65 and 80 for screening in 42 percent, 38 percent and 25 percent of cases, respectively.

“Ultimately, recommendations to perform CRC screening among patients of any age with unresectable NSCLC can be described as having no demonstrable clinical benefit, or even being harmful,” wrote the authors.

The researchers also looked at how screening modality choices were affected by patient characteristics, and they found PCPs were more likely to recommend fecal occult blood testing, rather than colonoscopy, for a healthy 80-year-old, compared with healthy 50- and 65-year-old patients (19 percent, 5 percent and 2 percent, respectively).

Obstetrics-gynecology physicians were more likely to recommend an 80-year-old with unresectable NSCLC for CRC screening, while PCPs with full EMRs were less likely to recommend screening, according to Haggstrom and colleagues.

“More research to understand the mechanisms of how such factors influence the over-recommendation of CRC screening may inform future medical education and policy interventions.”