Background:The US Preventive Services Task Force updated its colorectal cancer(CRC)screening guidelines in 2021,recommending screening for adults aged 45-49.This study aimed to evaluate CRC screening preva-lence among...Background:The US Preventive Services Task Force updated its colorectal cancer(CRC)screening guidelines in 2021,recommending screening for adults aged 45-49.This study aimed to evaluate CRC screening preva-lence among this newly eligible population and assess its association with healthcare provider supply and CT colonography facility availability in 2022.Methods:Using 2022 Behavioral Risk Factor Surveillance System data(n=25,592),we estimated CRC screening prevalence among adults aged 45-49 and the prevalence of different screening modalities across various sociode-mographic factors.We examined associations between screening rates and state-level healthcare provider supply using 2021-2022 Area Health Resources File data.Spearman rank-order correlations assessed relationships be-tween provider supply,CT colonography facility availability,and screening prevalence.Results:Overall CRC screening prevalence was 34.5%(95%CI:33.4%-35.8%).Endoscopic tests were most common(74.9%),followed by stool-based tests(9.3%)and CT colonography(0.5%).Significant variations in screening modalities were observed across sociodemographic factors.Gastroenterology physician supply posi-tively correlated with overall CRC screening prevalence(ρ=0.42,P=0.002)and endoscopy screening prevalence(ρ=0.38,P=0.005).CT colonography facility availability weakly correlated with CT colonography screening prevalence(ρ=0.15,P=0.316),although this was not significant.Conclusions:CRC screening rates among newly eligible adults aged 45-49 appear to be suboptimal in 2022.Dis-parities in screening methods across sociodemographic factors highlight potential access barriers,particularly for endoscopic tests.The association between gastroenterology physician supply and screening rates emphasizes the importance of addressing projected workforce shortages.Targeted efforts are needed to increase CRC screening uptake in this age group and ensure equitable access to screening services.展开更多
Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years o...Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.展开更多
文摘Background:The US Preventive Services Task Force updated its colorectal cancer(CRC)screening guidelines in 2021,recommending screening for adults aged 45-49.This study aimed to evaluate CRC screening preva-lence among this newly eligible population and assess its association with healthcare provider supply and CT colonography facility availability in 2022.Methods:Using 2022 Behavioral Risk Factor Surveillance System data(n=25,592),we estimated CRC screening prevalence among adults aged 45-49 and the prevalence of different screening modalities across various sociode-mographic factors.We examined associations between screening rates and state-level healthcare provider supply using 2021-2022 Area Health Resources File data.Spearman rank-order correlations assessed relationships be-tween provider supply,CT colonography facility availability,and screening prevalence.Results:Overall CRC screening prevalence was 34.5%(95%CI:33.4%-35.8%).Endoscopic tests were most common(74.9%),followed by stool-based tests(9.3%)and CT colonography(0.5%).Significant variations in screening modalities were observed across sociodemographic factors.Gastroenterology physician supply posi-tively correlated with overall CRC screening prevalence(ρ=0.42,P=0.002)and endoscopy screening prevalence(ρ=0.38,P=0.005).CT colonography facility availability weakly correlated with CT colonography screening prevalence(ρ=0.15,P=0.316),although this was not significant.Conclusions:CRC screening rates among newly eligible adults aged 45-49 appear to be suboptimal in 2022.Dis-parities in screening methods across sociodemographic factors highlight potential access barriers,particularly for endoscopic tests.The association between gastroenterology physician supply and screening rates emphasizes the importance of addressing projected workforce shortages.Targeted efforts are needed to increase CRC screening uptake in this age group and ensure equitable access to screening services.
文摘Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.
