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. Author manuscript; available in PMC: 2012 Mar 1.
Published in final edited form as: Arch Intern Med. 2011 May 9;171(15):1344–1351. doi: 10.1001/archinternmed.2011.206

Table 2.

Outcomes of Patients Diagnosed with Colorectal Cancer According to Whether They Received Follow-up of their Positive FOBT Result (N=13)

Prognostic
Group
Clinical Course
Patients who had a follow-up colonoscopy
Best Life
Expectancy
74 year-old active man with no Charlson comorbidities who had a follow-up colonoscopy
which found T2N1M0 colorectal cancer in 2002. He underwent curative hemicolectomy
without complications. He had 2 normal colonoscopies since surgery and remains alive and
healthy.
Best Life
Expectancy
73 year-old healthy man with no Charlson comorbidities who had a normal follow-up
colonoscopy. In 2006 he suddenly developed hematochezia and colonoscopy found T1N0M0
colorectal cancer for which he underwent curative hemicolectomy. He remained healthy until
2007 when he was diagnosed with congestive heart failure and died later that year from heart
failure.
Best Life
Expectancy
Healthy 71 year-old man with no Charlson comorbidities who had a follow-up colonoscopy
which found rectal cancer. He underwent curative right hemicolectomy complicated by
recurrent colostomy leakage. He remained relatively healthy until 2007 when he was
diagnosed with lung cancer and died shortly thereafter.
Average
Life
Expectancy
72 year-old man with emphysema who had a follow-up colonoscopy which found T1N0M0
colorectal cancer for which he underwent curative hemicolectomy without complications. He
has had 3 normal follow-up colonoscopies during the study period. He developed renal
failure in 2008 but remains alive.
Average
Life
Expectancy
81 year-old man with chronic obstructive pulmonary disease who had a follow-up
colonoscopy which found a 3cm colorectal cancer without metastases. He underwent
curative hemicolectomy, developed delirium requiring prolonged hospitalization, but
eventually recovered. He had progressive functional decline since surgery but remains alive.
Average
Life
Expectancy
81 year-old with diabetes and mild heart failure who had a follow-up colonoscopy which
found near obstructing colorectal cancer. He was referred for surgery but became
unresponsive and required emergent colectomy. He recovered from surgery but developed
progressive renal failure and remains alive in a nursing home.
Worst Life
Expectancy
74 year-old man with severe rheumatoid arthritis on chronic steroids, emphysema, and
prostate cancer who had a follow-up colonoscopy which found a T1N0M0 colorectal
cancerous polyp which was removed. Given a possibly inadequate resection, he had a sub-
total colectomy complicated by repeat hospitalizations for recurrent wound infections and
bowel obstruction. His chronic obstructive pulmonary disease worsened but he remains alive.
Patients who did not have a follow-up colonoscopy
Best Life
Expectancy
77 year-old active man with prostate cancer on androgen deprivation therapy (this
comorbidity was missed by claims data) who had a positive FOBT 2001. He was sent to GI
clinic but adamantly refused colonoscopy since “he has prostate cancer, he doesn’t want to
know if he has colon cancer.” He agreed to repeat FOBT 4 years later which was positive and
at that time was persuaded to have a colonoscopy which found T3N0M0 colon cancer. He
underwent curative hemicolectomy 2006 and remains alive.
Best Life
Expectancy
79 year-old healthy man with no Charlson comorbidities who had a positive FOBT 2001 but
repeatedly declined colonoscopy over the next 6 years as his hematocrit slowly fell. In 2007
he developed hematochezia and colonoscopy found two obstructing colorectal cancers.
Colonoscopy was complicated by aspiration requiring intubation delaying surgery for several
weeks. He underwent a hemicolectomy in 2007 which was complicated by renal failure and
sepsis and he died soon after in the ICU as a result of his late stage colorectal cancer.
Average
Life
Expectancy
75 year-old active man with diabetes who had a positive FOBT 2001 and his VA physician
recommended colonoscopy. Instead he had a sigmoidoscopy in 2001 which as done privately
and was normal per patient report. He felt well until he developed hematochezia in 2006 and
colonoscopy found Stage 3 colorectal cancer treated with resection, chemotherapy, and
radiation, and he remains alive without recurrence.
Average
Life
Expectancy
76 year-old man with a history of a myocardial infarction and coronary stents who had a
positive FOBT 2001 and was referred for colonoscopy. Instead he had a barium enema and
sigmoidoscopy due to his heart disease, which both found an obstructing colorectal cancer.
Further work-up found widely metastatic disease. He underwent palliative hemicolectomy
2001 complicated by a myocardial infarction, abdominal abscesses, and delirium requiring
prolonged hospitalization. He enrolled in hospice 2002 and died shortly afterwards of
metastatic colorectal cancer.
Average
Life
Expectancy
79 year-old obese man with diabetes on coumadin for atrial fibrillation who had a positive
FOBT 2001 and scheduled for colonoscopy but he suddenly developed abdominal pain and
narrow caliber stools so had a barium enema 2001 which found T3N1M0 colorectal cancer.
He was treated with hemicolectomy and declined adjuvant therapy. He was diagnosed with
metastatic disease 2001 and died shortly afterwards of metastatic colorectal cancer.
Worst Life
Expectancy
81 year-old man with stage III congestive heart failure, emphysema, diabetes with end-organ
damage who had a positive FOBT 2001 but refused colonoscopy since he had one in 1987 and
never wanted another. He developed progressive anemia and had a colonoscopy 2002 which
found Stage 2 colorectal cancer. He underwent hemicolectomy which was complicated by
pneumonia and he died shortly afterwards in the hospital.