277 Evaluating Cancer Outcomes of Outpatient Colonoscopies in Elderly Patients Older Than 85 Years of Age

Abstract

INTRODUCTION: With increasing life expectancy and a growing body of aging patients, the incidence of gastrointestinal diseases including colorectal cancer increases. Currently, there are few studies on cancer outcomes of outpatient colonoscopy in patients older than 85 years of age. METHODS: The endoscopic database at Scripps was queried for all outpatient colonoscopies performed under moderate sedation between April 1, 2012 to March 31, 2017 on patients aged 85 years and older. Endoscopy reports were reviewed for demographics, indication for procedure, and endoscopic findings. Variables including location and stage of tumor, subsequent treatments, and overall mortality were analyzed. RESULTS: 322 outpatient colonoscopies were reviewed. Median age was 86 years. 53% were females. Screening colonoscopies accounted for 2.1% of procedures. 40 (12.4%) colon cancers were detected. 38 (95%) were adenocarcinomas and 2 (5%) were neuroendocrine tumors. Of these, 26 (65%) were right sided colon cancers. Among patients diagnosed with cancer, anemia was the most common indication followed by positive fecal occult blood test (FOBT). 20 (50%) of these patients had a FOBT within the past year. Of those FOBTs, 18 (90%) were positive. Median age of patients with colon cancer was 88 years, with 70% females. 12 (30%) patients had never had a prior colonoscopy. Of those with colon cancer, 19 (47.5%) were diagnosed at an advanced-stage (stage III or IV). Among patients who received treatment, 32 (80%) pursued surgery, 10 (25%) received chemotherapy, and 5 (12.5%) received radiation. 3 (7.5%) patients received supportive care only. 1-year mortality was 22.5% and 3-year mortality was 40% from the time of diagnosis. CONCLUSION: To date, this is the first study in the United States that examines cancer outcomes in an elderly population over age 85 undergoing an outpatient colonoscopy. Overall, colonoscopies in this age group resulted in a high cancer detection rate with anemia being the most common indication for a colonoscopy. Almost half of the detected cancers were advanced-stage and prognosis was overall poor. Interestingly, FOBT may be a useful screening tool to help clinicians assess whether a colonoscopy should be pursued in the elderly population. These findings will hopefully provide clinicians guidance on screening tools and treatment options that can be offered to the growing elderly population.