Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States

<p>Abstract</p> <p>Background</p> <p>Clinical practice guidelines recommend colonoscopies at regular intervals for colorectal cancer (CRC) survivors. Using data from a large, multi-regional, population-based cohort, we describe the rate of surveillance colonoscopy and its association with geographic, sociodemographic, clinical, and health services characteristics.</p> <p>Methods</p> <p>We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Eligible survivors were diagnosed between 2003 and 2005, had curative surgery for CRC, and were alive without recurrences 14 months after surgery with curative intent. Data came from patient interviews and medical record abstraction. We used a multivariate logit model to identify predictors of colonoscopy use.</p> <p>Results</p> <p>Despite guidelines recommending surveillance, only 49% of the 1423 eligible survivors received a colonoscopy within 14 months after surgery. We observed large regional differences (38% to 57%) across regions. Survivors who received screening colonoscopy were more likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90); have visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82); and received adjuvant chemotherapy (OR = 1.75, 95% CI: 1.27-2.41). Compared to survivors with no comorbidities, survivors with moderate or severe comorbidities were less likely to receive surveillance colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively).</p> <p>Conclusions</p> <p>Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.</p

RELATIONSHIPS OF BODY COMPOSITION FACTORS WITH COMPONENTS OF PHYSICAL ACTIVITY AND MUSCULAR FITNESS

Andrew D. Fields, Katherine Sullivan, Casey Metoyer, Jacob Broeckel, Madelyn K. Simmang, Mary Lovelady, Maddy Schwing, Michael V. Fedewa, Michael R. Esco, FACSM. University of Alabama, Tuscaloosa, AL. BACKGROUND: It is commonly accepted that body composition is related to physical activity (PA) and muscular fitness (MF). However, it is not as well understood if metrics of PA and MF can explain the variance in both fat mass (FM) and fat-free mass (FFM). PURPOSE: The purpose of this investigation was to determine the extent of variation in FM and FFM that can be explained by specific components of PA and MF. METHODS: A convenience sample of participants was recruited for this study (n=37, 27.03% Female, 22.35±3.76 yrs.). All metrics were assessed during a single visit to the Exercise Physiology Lab. Body mass (BM) was measured to the nearest 0.1 kg with a calibrated digital scale (Tanita BWB-800, Tanita Corporation, Tokyo, Japan). Results from the International Physical Activity Questionnaire (IPAQ) Short-Form were converted to calculate the intensity and amount of weekly PA in MET-minutes per week (MET-min/wk). Intensities were categorized into vigorous, moderate, and walking based on IPAQ standards. FM was estimated using brightness-mode ultrasound (Philips iU22, Philips Medical Systems, Andover, MA, USA) across seven standardized sites. FFM was derived from subtracting FM from BM. Handgrip strength (HGS) was assessed on dominant hand via a hydraulic hand dynamometer (Alphamed Inc., Lakewood, NJ, USA) as a metric of muscular strength, and a maximum-rep push-up test was administered to quantify muscular endurance. The correlations between PA, MF, FM, and FFM were assessed using Pearson’s r, and described as weak, moderate, or strong (r=0.2, 0.5, or 0.8, respectively). Data are presented as mean±standard deviation, with an alpha level set to p\u3c0.05. RESULTS: There were no significant correlations found between FM and any of the PA or MF measures, (r=-0.28 to 0.24, all p\u3e0.05). FFM was moderately correlated with vigorous MET-min/wk (r=0.34, p=0.04) and walking MET-min/wk, (r=-0.37, p=0.02), and strongly correlated with and HGS (r=0.80, p\u3c0.001). Stepwise regression analysis showed that only HGS and vigorous MET-min/wk were included in the model that explained the variance in FFM (R2=0.74, p\u3c0.001). DISCUSSION: The results indicate that muscular strength and vigorous PA have stronger relationships with FFM than muscular endurance or other, lower-intensity metrics of PA. FM does not appear to be related to either MF parameters or IPAQ-derived PA

A importância da suspeição clínica no diagnóstico e tratamento do câncer colorretal hereditário The importance of clinical suspicion on the diagnosis and treatment of hereditary colorectal cancer

Neste trabalho relatamos o caso de um paciente portador de síndrome de Lynch (HNPCC) que desenvolveu câncer retal metacrônico em curto intervalo de tempo após tratamento do tumor primário (câncer de cólon direito). O objetivo deste relato de caso é salientar a importância da suspeição clínica no diagnóstico de câncer colorretal hereditário e suas implicações terapêuticas.<br>In this article we report the case of a patient with Lynch syndrome (HNPCC) who developed metachronic rectal cancer in a short time interval after the primary tumor had been treated (right colon cancer). The objective of this case report is to point out the importance of clinical suspicion in the diagnosis of hereditary colorectal cancer and its therapeutics implications