Scientists have found high rate of colon cancer screening among US patients on dialysis even though the patients rarely benefit from such screenings.
University of California, San Francisco, MD Kirsten Johansen and Christopher Carlos led a study to look at how many US dialysis patients aged 50 years were being screened for colon cancer and whether such a testing was appropriately targeted toward healthier patients on dialysis. For the study the team looked at 469,574 Medicare beneficiaries receiving dialysis between 2007 and 2012 and ranked them according to their expected survival.
Over a median follow-up of 1.5 years, 11.6 per cent of patients received a colon cancer screening with analysis indicating that the healthiest quarter of patients were 1.53-times more likely to be screened than the sickest quarter of patients, and those most likely to receive a kidney transplant were 1.68-times more likely to be screened than those least likely to receive a kidney transplant.
Although screening was performed more often among healthier patients, the overall screening rate was fairly high, at a rate of 27.9 colonoscopies per 1000 person-years. This rate is over 8-times higher than the rate of 3.4 per 1000 person-years found among Medicare beneficiaries not on dialysis with similarly limited life expectancies.
Authors of the study published in the Journal of the American Society of Nephrology (JASN) recommend against colon cancer screening among patients receiving maintenance dialysis with limited life expectancy and without signs or symptoms. Authors also note that their study and the findings could act as a starting point for future studies that assess the impact of the Choosing Wisely campaign, which seeks to reduce waste in the healthcare system