Colonoscopy in Colorectal Cancer Patients with Multiple Chronic Conditions

 描述(申请人提供)：结直肠癌(CRC)是美国第三常见的癌症。大约65%的新的CRC和大约75%的CRC死亡发生在65岁或以上的患者中。大约40%的大肠癌会复发或复发，许多患者会死于他们的疾病，除非及早发现并接受根治治疗。几项研究表明，根治性手术后监测结肠镜检查以检测局部复发对生存有好处。专业组织建议术后1年、4年和9年进行结肠镜检查(以下简称“指南”)。该指南在许多有其他慢性病(ACC)的结直肠癌患者中的有效性尚不清楚。ACC被定义为CRC患者中任何额外的慢性疾病，也称为共病，在CRC患者中非常普遍；超过65%的65岁或65岁以上的患者至少有一种ACC。ACCS可能会影响复发风险或缩短预期寿命，从而影响监视结肠镜检查的有效性。结肠镜检查也有很大的风险，包括心肺并发症、穿孔，甚至死亡。合并ACC的结直肠癌患者发生并发症的风险增加，这可能与准备、镇静或结肠镜检查程序本身有关。我们的总体目标建立在这些发现的基础上，以确定该指南在患有特定ACC的老年CRC患者中的安全性和有效性的差异，这将通过完善旨在最大化预后、减少并发症和降低成本的临床决策，为这些患者提供量身定制的随访策略。根据其对CRC复发和死亡的风险以及在CRC患者中的患病率来选择特定的ACC。目的1.描述结直肠癌患者使用监视结肠镜检查的方式。目的2.描述并比较老年结直肠癌患者行结肠镜检查的并发症发生率。目的3.描述和比较结肠镜检查在结直肠癌患者中的有效性，特别是疾病复发、手术切除和死亡的风险。我们将使用1999-2011年大规模的、高质量的、基于人群的、真实世界的、联系监测、流行病学和最终结果(SEER)-联邦医疗保险数据和先进的方法来比较66岁或66岁以上患有ACC的CRC患者指南的安全性和有效性的差异。这一修改后的应用程序可能会对患者的预后、现实世界的临床护理实践、当地的卫生保健资源和财务成本产生巨大的影响，并鉴于接受术后监测的结直肠癌患者的数量越来越多，因此推进了对患有ACC的结直肠癌患者的比较有效性研究领域。它还将为未来大量的项目提供广泛的数据。

 DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the third most common cancer in U.S. About 65% of new CRCs and about 75% of CRC deaths occur among patients age 65 or older. About 40% of CRCs will relapse with metastatic disease or recurrence and many patients will die of their disease unless detected early enough to receive curative treatment. Several studies suggest a survival benefit of surveillance colonoscopy after curative surgery to detect local recurrence. Professional organizations recommend surveillance colonoscopy 1, 4, and 9 years after surgery (hereafter the "guideline"). The effectiveness of this guideline among the many CRC patients with additional chronic conditions (ACC) is unknown. ACC is defined as any additional chronic condition among CRC patients, also known as comorbidity, and are highly prevalent among CRC patients; over 65% of patients age 65 years or older have at least one ACC. ACCs could impact the effectiveness of surveillance colonoscopy by affecting the risk of recurrence or reducing life expectancy. Colonoscopy also carries significant risks, including cardiopulmonary complications, perforation, and even death. CRC patients with ACC (using a comorbidity index) are at increased risk of complications, which may be related to the preparation, sedation, or the colonoscopy procedure itself. Our overarching goal builds upon these findings to determine differences in safety and effectiveness of the guideline among elderly CRC patients with specific ACCs that will lead to tailored follow-up strategies for these patients by refining clinical decision making designed to maximize prognosis, reduce complications, and reduce cost. Specific ACC are selected based on their risk on CRC recurrence and death, and prevalence in CRC patients. Aim 1. Describe patterns of use of surveillance colonoscopy among CRC patients with specific ACCs. Aim 2. Describe and compare the incidence of complications resulting from surveillance colonoscopy among elderly CRC patients with specific ACCs. Aim 3. Describe and compare the effectiveness of surveillance colonoscopy among CRC patients with specific ACCs, particularly their risk of disease relapse, surgical resection, and death. We will use the 1999-2011 large, high-quality, population-based, real-world, linked Surveillance, Epidemiology, and End Result (SEER)-Medicare data and advanced methods to compare differences in the safety and effectiveness of the guideline among CRC patients aged 66 or older with ACC. This amended application could have a huge impact on patient outcomes, real-world clinical care practices, local health care resources, and financial costs, and advance the field of comparative effectiveness research in CRC patients with ACC given the large and growing number of CRC patients undergoing postoperative surveillance. It also will provide extensive data for ample future projects.