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IIR 17-050 – HSR&D Study

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IIR 17-050
Prevalence, Risk Factors and Outcomes of Post-colonoscopy Colorectal Cancer in Veterans
Thomas F. Imperiale MD
Richard L. Roudebush VA Medical Center, Indianapolis, IN
Indianapolis, IN
Funding Period: July 2018 - June 2021

BACKGROUND/RATIONALE:
Colorectal cancer (CRC) that occurs after a colonoscopy showing no CRC but prior to the recommended interval for follow-up colonoscopy is referred to as "post-colonoscopy CRC" (PCCRC). PCCRC results from missed colorectal lesions, incompletely resected lesions, or from de novo, fast-growing lesions. A robust, but heterogeneous literature shows that 3-9% of all CRCs are ICCs. More limited studies show an inconsistent effect of PCCRC on patient outcomes as compared to (diagnosed colorectal cancer) DCRC, and attribute PCCRC to specific colonoscopy-related factors and to polyp characteristics. As the prevalence of PCCRC, its associated factors, and effect on patient outcomes have not been well-studied within VHA.

OBJECTIVE(S):
1) Quantify the a) prevalence and incidence, and b) outcomes of PCCRC in Veterans, as compared with DCRC; 2) Assess the role of colonoscopy-related factors, polyp characteristics, patient factors, and facility factors for the risk for CRC after colonoscopy a) with polypectomy, and; b) without polypectomy

METHODS:
Using VA electronic databases (VA Central Cancer Registry, Corporate Data Warehouse, VA-CMS data repository, VA Informatics and Computer Infrastructure, VA Vital Status File, and others), we will perform a retrospective cross-sectional study (for prevalence), a retrospective cohort study (for incidence and outcomes) and nested case-control studies (to identify risk factors). The retrospective cross-sectional study will quantify prevalence of PCCRC, using definitions consistent with the published literature and experience from other large healthcare systems in order to facilitate comparison of PCCRC prevalence with those other systems for the interval 1/1/06-12/31/2011. From all patients undergoing colonoscopy during this interval, we will calculate PCCRC incidence for Veterans with non-advanced neoplasia and no neoplasia for whom a 5-year and 10-year surveillance / rescreening interval, respectively, is recommended. Incidence and prevalence estimates will be adjusted for diagnostic-error rates, which will be based on manual medical record review. We will conduct a retrospective cohort study to compare Veterans aged 50-85 years diagnosed with PCCRC to those diagnosed with DCRC between 1/1/2006 and 12/31/2011, examining the primary outcome of 5-year overall survival and secondary outcomes of urgent hospitalization, disease stage, surgery, and 30-day post-operative mortality. Multivariate analysis will include adjustment for covariates including age, sex, rurality, comorbidity, and cancer site. For all CRC diagnosed between 2004 and 2011, we will use a case-control study (CCS) design to identify risk factors for PCCRC among Veterans ages 50-85 years who did or did not have polypectomy. Cases will be Veterans with PCCRC either following polypectomy (CCS-1) or not (CCS-2). For both CCSs, controls will be Veterans who do not have PCCRC during the same timeframe as that of the cases. Exposure variables will be procedure-related (extent of exam, preparation quality, others), endoscopist-related (specialty, level of training, others), and institution-related (volume, mechanisms for ensuring follow-up, complexity, others). Odds ratios and attributable (etiologic) fractions will be derived using multiple logistic regression and Greenland's method for logistic regression, respectively.

FINDINGS/RESULTS:
As of 5/17/2018, no findings are available to report.

IMPACT:
Impact information is not available as of 5/17/2018.

PUBLICATIONS:
None at this time.


DRA: Cancer
DRE: Prevention, TRL - Applied/Translational
Keywords: Cancer, Clinical Diagnosis and Screening
MeSH Terms: none