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.