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Surgical Endoscopy

, Volume 21, Issue 8, pp 1434–1440 | Cite as

Care within a Veterans Hospital

Earlier detection of colon cancer
  • P. van Roessel
  • R. V. Rouse
  • S. M. Wren
Article
  • 60 Downloads

Abstract

Background

In 1998 the Veterans Administration mandated an externally monitored targeted colon cancer screening rate that was expected to result in earlier cancer detection and improved patient survival. The effectiveness of the protocol was evaluated in a retrospective case series at a tertiary care Veterans Administration Hospital that included all patients with the diagnosis of colon cancer between 1991 and 2003.

Methods

Tumor stage, tumor location, and patient survival data were recorded and compared to National Cancer Data Base (NCDB) benchmarks.

Results

The study facility had a greater percentage of early cancers and fewer later stage cancers than the NCDB benchmark. Overall survival was better for the VA cohort compared to NCDB (all-cause 5-year survival: VA, 0.72; NCDB, 0.47. p ≤ .001).

Conclusions

The VA facility had a significantly greater percentage of early cancers and fewer stage III or IV cancers compared to a national benchmark and significantly improved survival compared to the national benchmark.

Keywords

Colorectal cancer Colon cancer Screening Cancer staging Veterans Affairs Health Care System Performance measure 

References

  1. 1.
    Asch SM, McGlynn EA, Hogan MM, Hayward RA, Shekelle P, Rubenstein L, Keesey J, Adams J, Kerr EA (2004) Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med 141: 938–945PubMedGoogle Scholar
  2. 2.
    Battat AC, Rouse RV, Dempsey L, Safadi BY, Wren SM (2004) Institutional commitment to rectal cancer screening results in earlier-stage cancers on diagnosis. Ann Surg Oncol 11: 970–976PubMedCrossRefGoogle Scholar
  3. 3.
    Brawarsky P, Brooks DR, Mucci LA, Wood PA (2004) Effect of physician recommendation and patient adherence on rates of colorectal cancer testing. Cancer Detect Prev 28: 260–268PubMedCrossRefGoogle Scholar
  4. 4.
    Breen N, Wagener DK, Brown ML, Davis WW, Ballard-Barbash R (2001) Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst 93: 1704–1713PubMedCrossRefGoogle Scholar
  5. 5.
    Brenes GA, Paskett ED (2000) Predictors of stage of adoption for colorectal cancer screening. Prev Med 31: 410–416PubMedCrossRefGoogle Scholar
  6. 6.
    Cucino C, Buchner AM, Sonnenberg A (2002) Continued rightward shift of colorectal cancer. Dis Colon Rectum 45: 1035–1040PubMedCrossRefGoogle Scholar
  7. 7.
    Dolan NC, Ferreira MR, Davis TC, Fitzgibbon ML, Rademaker A, Liu D, Schmitt BP, Gorby N, Wold M, Bennett CL (2004) Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: does literacy make a difference? J Clin Oncol 22: 2617–2622PubMedCrossRefGoogle Scholar
  8. 8.
    Fleming ID, Cooper JS, Hensen DE, Hutter RV, Kennedy BJ, Murphy GP, et al. (1997) American Joint Commission on Cancer (AJCC) Staging Manual, Fifth Ed. Philadelphia: Lippincott-RavenGoogle Scholar
  9. 9.
    Frazier AL, Colditz GA, Fuchs CS, Kuntz KM (2000) Cost-effectiveness of screening for colorectal cancer in the general population. JAMA 284: 1954–1961PubMedCrossRefGoogle Scholar
  10. 10.
    Gupta AK, Melton LJ, Petersen GM, Timmons L, Vege S, Harmsen W, Diehl N, Zinsmeister A, Ahlquist D (2005) Changing trends in the incidence, stage, survival, and screen-detection of colorectal cancer: A population-based study. Clin Gastroenterol Hepatol 3: 150–158PubMedCrossRefGoogle Scholar
  11. 11.
    Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, James PD, Mangham CM (1996) Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348: 1472–1477PubMedCrossRefGoogle Scholar
  12. 12.
    Holt WS Jr (1991) Factors affecting compliance with screening sigmoidoscopy. J Fam Pract 32: 585–589PubMedGoogle Scholar
  13. 13.
    Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, Feuer EJ, Thun MJ (2005) Cancer statistics, 2005. CA Cancer J Clin 55: 10–30PubMedGoogle Scholar
  14. 14.
    Jha AK, Perlin JB, Kizer KW, Dudley RA (2003) Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med 348: 2218–2227PubMedCrossRefGoogle Scholar
  15. 15.
    Kerr EA, Gerzoff RB, Krein SL, Selby JV, Piette JD, Curb JD, Herman WH, Marrero DG, Narayan KMV, Safford MM, Thompson T, Mangione CM (2004) Diabetes care quality in the Veterans Affairs Health Care System and commercial managed care: the TRIAD study. Ann Intern Med 141: 272–281PubMedGoogle Scholar
  16. 16.
    Lewis SF, Jensen NM (1996) Screening sigmoidoscopy. Factors associated with utilization. J Gen Intern Med 11: 542–544PubMedCrossRefGoogle Scholar
  17. 17.
    Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 328: 1365–1371PubMedCrossRefGoogle Scholar
  18. 18.
    Manne S, Markowitz A, Winawer S, Meropol NJ, Haller D, Rakowski W, Babb J, Jandorf L (2002) Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer. Health Psychol 21: 3–15PubMedCrossRefGoogle Scholar
  19. 19.
    Mostafa G, Matthews BD, Norton HJ, Kercher KW, Sing RF, Heniford BT (2004) Influence of demographics on colorectal cancer. Am Surg 70: 259–264PubMedGoogle Scholar
  20. 20.
    Pignone M, Saha S, Hoerger T, Mandelblatt J (2002) Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 137: 96–104PubMedGoogle Scholar
  21. 21.
    Public Access NCDB Benchmark Reports. National Cancer Data Base: American College of Surgeons. http://www.web.facs.org/ncdbbmr/ncdbbenchmarks.cfm. Accessed February 15, 2005
  22. 22.
    Public Access NCDB Survival Reports. National Cancer Data Base: American College of Surgeons. http://www.web.facs.org/ncdbr/surv.cfm. Accessed February 15, 2005
  23. 23.
    Rabeneck L, Davila JA, El-Serag HB (2003) Is there a true “shift” to the right colon in the incidence of colorectal cancer? Am J Gastroenterol 98: 1400–1409PubMedGoogle Scholar
  24. 24.
    Ramsey SD, Mandelson MT, Berry K, Etzioni R, Harrison R (2003) Cancer-attributable costs of diagnosis and care for persons with screen-detected versus symptom-detected colorectal cancer. Gastroenterology 125: 1645–1650PubMedCrossRefGoogle Scholar
  25. 25.
    Seeff LC, Nadel MR, Blackman D (2003) Colorectal cancer test use among persons aged >50 years—United States. Morb Mortal Wkly Rep 52: 193–196Google Scholar
  26. 26.
    Seeff LC, Nadel MR, Klabunde CN, Thompson T, Shapiro JA, Vernon SW, Coates RJ (2004) Patterns and predictors of colorectal cancer test use in the adult U.S. population. Cancer 100: 2093–2103PubMedCrossRefGoogle Scholar
  27. 27.
    Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS (1992) A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 326: 653–657PubMedCrossRefGoogle Scholar
  28. 28.
    Smith RA, von Eschenbach AC, Wender R (for the ACS Cancer Advisory Committee) (2001) American Cancer Society guidelines for the early detection of cancer: Update of early detection guidelines for prostate, colorectal, and endometrial cancers. CA Cancer J Clin 51: 38–75PubMedCrossRefGoogle Scholar
  29. 29.
    VHA Performance Measurement Data: EPRP Reports. Office of Quality, Performance, Veterans Health Administration, Department of Veterans Affairs 1999–2003Google Scholar
  30. 30.
    Walter LC, Davidowitz NP, Heineken PA, Covinsky KE (2004) Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure. JAMA 291: 2466–2470PubMedCrossRefGoogle Scholar
  31. 31.
    Winawer SJ (2001) A quarter century of colorectal cancer screening: progress and prospects. J Clin Oncol 19: 6S–12SPubMedGoogle Scholar
  32. 32.
    Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, Ganiats T, Levin T, Woolf S, Johnson D, Kirk L, Litin S, Simmang C, Gastrointestinal Consortium Panel (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale—Update based on new evidence. Gastroenterology 124: 544–560PubMedCrossRefGoogle Scholar
  33. 33.
    Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET, The National Poly Study Workgroup (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329: 1977–1981PubMedCrossRefGoogle Scholar
  34. 34.
    Zapka JG, Puleo E, Vickers-Lahti M, Luckmann R (2002) Healthcare system factors and colorectal cancer screening. Am J Prev Med 23: 28–35PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Stanford University School of MedicineStanford UniversityPalo AltoUnited States
  2. 2.Department of PathologyStanford University School of Medicine, Stanford UniversityPalo AltoUnited States
  3. 3.Department of PathologyPalo Alto Veteran’s Affairs Health Care SystemPalo AltoUnited States
  4. 4.Department of SurgeryStanford University School of MedicinePalo AltoUnited States
  5. 5.Department of SurgeryPalo Alto Veteran’s Affairs Health Care SystemPalo AltoUnited States

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