scholarly journals Impact of Follow-Up Colonoscopy Quality on Canadian Colorectal Cancer Outcomes and Costs

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 45s-45s
Author(s):  
N. Fitzgerald ◽  
S. Memon ◽  
C. Gauvreau ◽  
S. Hussain ◽  
W. Flanagan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Outcomes ◽  
Poor Compliance ◽  
Average Risk ◽  
Microsimulation Model ◽  
High Quality ◽  
Diagnostic Colonoscopy ◽  
Incomplete Colonoscopy ◽  
Colonoscopy Quality

Background: Most colorectal cancer (CRC) cases develop from precancerous polyps. Screening using fecal testing for occult blood, with follow-up diagnostic colonoscopy to remove polyps, can prevent invasive cancer from occurring. However, there is variation in the quality of colonoscopy, which may result in nonoptimal health outcomes. Aim: We evaluated the impact of follow-up colonoscopy quality on health outcomes, resource utilization and costs using the OncoSim-CRC microsimulation model (version 2.5). Methods: OncoSim is a microsimulation model led by the Canadian Partnership Against Cancer with model development by Statistics Canada. We compared results of high quality follow-up colonoscopy after positive fecal immunochemical testing (FIT) (colonoscopy sensitivity for cancer detection= 95%; compliance to follow-up colonoscopy = 85%) with that of reduced quality colonoscopy. Variations in colonoscopy performance were simulated through plausible overall effectiveness reduction (ER) and incomplete colonoscopy (IC). Screening system/patient follow-up deficiencies were simulated through poor compliance to diagnostic colonoscopy (PC). Modeling assumptions included: Biennial FIT screening of average-risk people aged 50-74; positive FIT followed by diagnostic colonoscopy; ER = 20% reduction in overall sensitivity; IC = zero sensitivity in proximal colon; PC = compliance reduction by 50%. Overall cost was calculated for 2017-2036 in undiscounted 2016 CAD, and included screening, treatment and end-of-life costs. Results: Compared with high quality colonoscopy follow-up, incomplete colonoscopy with poor compliance over 20 years led to as many as 12% new cases of CRC; 23% more CRC deaths; 89% more interval cancers; and 6% increased costs to the health care system, annually. Conclusion: Reduced colonoscopy quality can lead to considerable declines in the predicted effectiveness of screening and to increased costs to the healthcare system. Efforts to increase and maintain colonoscopy performance is a necessary component of CRC control planning.

scholarly journals Colorectal Cancer Surveillance after Index Colonoscopy: Guidance from the Canadian Association of Gastroenterology

2013 ◽  
Vol 27 (4) ◽  
pp. 224-228 ◽  
Author(s):  
Desmond Leddin ◽  
Robert Enns ◽  
Robert Hilsden ◽  
Carlo A Fallone ◽  
Linda Rabeneck ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Task Force ◽  
Cancer Surveillance ◽  
Screening Tests ◽  
Average Risk ◽  
Health Care Environment ◽  
Canadian Association ◽  
The Us ◽  
Colonoscopy Surveillance

BACKGROUND: Differences between American (United States [US]) and European guidelines for colonoscopy surveillance may create confusion for the practicing clinician. Under- or overutilization of surveillance colonoscopy can impact patient care.METHODS: The Canadian Association of Gastroenterology (CAG) convened a working group (CAG-WG) to review available guidelines and provide unified guidance to Canadian clinicians regarding appropriate follow-up for colorectal cancer (CRC) surveillance after index colonoscopy. A literature search was conducted for relevant data that postdated the published guidelines.RESULTS: The CAG-WG chose the 2012 US Multi-Society Task Force (MSTF) on Colorectal Cancer to serve as the basis for the Canadian position, primarily because the US approach was the simplest and comprehensively addressed the issue of serrated polyps. Aspects of other guidelines were incorporated where relevant. The CAG-WG recommendations differed from the US MSTF guidelines in three main areas: patients with negative index colonoscopy should be followed-up at 10 years using any of the appropriate screening tests, including colonos-copy, for average-risk individuals; among patients with >10 adenomas, a one-year interval for subsequent colonoscopy is recommended; and for long-term follow-up, patients with low-risk adenomas on both the index and first follow-up procedures can undergo second follow-up colonos-copy at an interval of five to 10 years.DISCUSSION: The CAG-WG adapted the US MSTF guidelines for colonoscopy surveillance to the Canadian health care environment with a few modifications. It is anticipated that the present article will provide unified guidance that will enhance physician acceptance and encourage appropriate utilization of recommended surveillance intervals.

scholarly journals Colorectal cancer in patients with single versus double positive faecal immunochemical test results: A retrospective cohort study from a public tertiary hospital

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0250460
Author(s):  
Tian Zhi Lim ◽  
Jerrald Lau ◽  
Gretel Jianlin Wong ◽  
Ker-Kan Tan
Keyword(s):  
Colorectal Cancer ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Screening Program ◽  
Tertiary Hospital ◽  
Colorectal Polyp ◽  
Diagnostic Colonoscopy ◽  
Positive Group ◽  
Immunochemical Test

Background Screening for colorectal cancer (CRC) using the faecal immunochemical test (FIT) is widely advocated. Few studies have compared the rate of detecting colonoscopic pathologies in single compared to double FIT-positive follow-up colonoscopy-compliant individuals in a two-sample national FIT screening program. Objective To compare CRC incidence in double FIT-positive versus single FIT-positive individuals using a retrospective cohort of patients from a tertiary hospital in Singapore. Design Retrospective cohort study. Setting Data was extracted from one public tertiary hospital in Singapore. Participants 1,422 FIT-positive individuals from the national FIT screening program who were referred to the hospital from 1st January 2017 to 31st March 2020 for follow-up consultation and diagnostic colonoscopy. Measurements The exposure of interest was a positive result on both FIT kits. The main outcome was a follow-up diagnostic colonoscopy finding of CRC. The secondary outcome was a diagnostic colonoscopy finding of a colorectal polyp. Results Incidence density of CRC was 1.15 and 13.10 per 100,000 person-months, in the single and double FIT-positive group, respectively. This resulted in an incidence rate ratio of 11.40 (95% CI = 4.34, 35.09). Colorectal polyp detection was significantly higher (p < 0.01) in the double (103 of 173 participants; 59.5%) compared to the single (279 of 671 participants; 41.6%) FIT-positive group. Limitations The key limitation of this study was the relatively small cohort derived from a single tertiary hospital, as this had the effect of limiting the number of incident cases, resulting in comparatively imprecise CIs. Conclusions Double FIT-positive individuals are significantly more likely to have a colonoscopy finding of incident CRC or premalignant polyp than single FIT-positive individuals. Clinicians and policymakers should consider updating their CRC screening protocols accordingly.

scholarly journals High-quality Follow-up System for Colorectal Cancer-A Computer Registration and Administration System-

2006 ◽  
Vol 59 (10) ◽  
pp. 869-873
Author(s):  
K. Shirouzu ◽  
H. Murakami ◽  
S. Ogou ◽  
Y. Akagi ◽  
Y. Ogata
Keyword(s):  
Colorectal Cancer ◽  
High Quality ◽  
Administration System

Validation of the NCI colorectal cancer risk assessment tool in the CSP 380 veterans cohort.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15135-e15135
Author(s):  
Laura W. Musselwhite ◽  
Thomas S. Redding ◽  
Kellie J. Sims ◽  
Meghan O'Leary ◽  
Elizabeth R. Hauser ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Assessment ◽  
Predictive Value ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Sensitivity Analyses ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Male Veterans

e15135 Background: Refining screening to colorectal cancer (CRC) risk may promote screening effectiveness. We applied the National Cancer Institute (NCI) CRC Risk Assessment Tool to estimate 5- and 10-year CRC risk in an average-risk Veterans cohort undergoing screening colonoscopy with follow-up. Methods: This was a prospective evaluation of predicted to actual risk of CRC using the NCI CRC Risk Assessment Tool in male Veterans undergoing screening colonoscopy with a median follow-up of 10 years.Family, medical, dietary and physical activity histories were collected at enrollment and used to calculate absolute 5- and 10-year CRC risk, and to compare tertiles of expected to observed CRC risk. Sensitivity analyses were performed. Results: For 2,934 male Veterans with complete data (average age 62.4 years, 15% minorities), 1.3% (N=30) and 1.7% (N=50) were diagnosed with CRC within 5 and 10 years of survey completion. The area under the curve for predicting CRC was 0.69 (95% CI; 0.61-0.78) at 5 years and 0.67 (95% CI, 0.59-0.75) at 10 years. We calculated the sensitivity (0.60, 95% CI; 0.45-0.73), specificity (0.67, 95% CI; 0.65-0.69) positive predictive value (0.031, 95% CI; 0.02-0.04) and negative predictive value (0.99, 95% CI; 0.98-0.99). Conclusions: The NCI CRC Risk Assessment Tool was well-calibrated at 5 years and overestimated CRC risk at 10 years, had modest discriminatory function, and a high NPV in a cohort of ethnically diverse male Veterans. This tool reliably excludes 10-year CRC in low-scoring individuals and may inform patient-provider decision making when the benefit of screening is uncertain. [Table: see text]

Early detection of lower GI tract tumors by dedicated assessment of the colon on routine computed tomography (CT) imaging: An observational study.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 510-510
Author(s):  
John Chang ◽  
Russell Pluhm ◽  
Ashley Lutrick ◽  
Jessica Guerra ◽  
Phillip Koo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Early Detection ◽  
Lymph Nodes ◽  
Tertiary Care ◽  
Transitional Cell ◽  
Wall Thickening ◽  
Average Risk ◽  
Care Hospital ◽  
Early Features

510 Background: We have previously reported that up to 48% of the early features of colorectal cancer (subtle wall thickening, pericolonic stranding, and small lymph nodes in the draining nodal station) were not identified on the original CT abdomen and pelvis (CTAP) reports. This resulted in a 36% decrease in five-year survival based on historical data. In this report, we assessed whether dedicated assessment of the colon on routine CT scans could lead to early detection of colorectal cancer. Methods: 210 CTAPs over a three-month period were screened from the emergency room records at a tertiary care hospital. 194 scans met eligibility. Exclusion criteria included: cases known to the evaluating radiologist and age ≤ 19 or > 89 years. No study was excluded for suboptimal image quality. The original report was reviewed for abnormalities involving the colon, mesentery and bowel and was recorded. A blinded evaluation of the eligible case was then performed by a board-certified radiologist with attention specifically to the colon and the mesentery for the suspicious early features of CRC. The concordance and discordance was then tabulated. Discordant findings were re-evaluated to determine if the discordance was true. Results: 72/194 patients were male, median age 44.5 years (range 20 - 89). 55/194 patients (29.1%) included in the study were noted to have suspicious features. 26 had abnormal lymph nodes, 24 had abnormal colonic wall thickening and 16 had pericolonic stranding and/or wall edema. 45/55 studies were truly discordant from the original interpretation. These included one missed colorectal cancer (confirmed), one likely small bowel neuroendocrine tumor (no follow up), and one likely transitional cell carcinoma of the right renal pelvis (no follow up). Conclusions: Dedicated search of the colon and mesentery on CTAP can identify subtle findings, although their true relevance is being evaluated in a larger future study. Our observational data does indicate that there maybe a potential role for a focused evaluation of the colon and mesentery on routine CTAP in an attempt to potentially increase the rate of cancer detection especially in younger low-average risk patients.

scholarly journals Evaluating the Cost-Effective Use of Follow-Up Colonoscopy Based on Screening Findings and Age

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Grace N. Joseph ◽  
Farid Heidarnejad ◽  
Eric A. Sherer
Keyword(s):  
Colorectal Cancer ◽  
Growth Models ◽  
Cost Effective ◽  
Colorectal Adenomas ◽  
Screening Colonoscopy ◽  
Average Risk ◽  
Life Years ◽  
Effective Use ◽  
The Cost

Introduction. Colorectal cancer (CRC), if not detected early, can be costly and detrimental to one’s health. Colonoscopy can identify CRC early as well as prevent the disease. The benefit of screening colonoscopy has been established, but the optimal frequency of follow-up colonoscopy is unknown and may vary based on findings from colonoscopy screening and patient age. Methods. A partially observed Markov process (POMP) was used to simulate the effects of follow-up colonoscopy on the development of CRC. The POMP uses adenoma and CRC growth models to calculate the probability of a patient having colorectal adenomas and CRC. Then, based on mortality, quality of life, and the costs associated with diagnosis, treatment, and surveillance of colorectal cancer, the overall costs and increase in quality-adjusted life years (QALYs) are calculated for follow-up colonoscopy scenarios. Results. At the $100,000/QALY gained threshold, only one follow-up colonoscopy is cost-effective only after screening at age 50 years. The optimal follow-up is 8.5 years, which gives 84.0 QALYs gained/10,000 persons. No follow-up colonoscopy was cost-effective at the $50,000 and $75,000/QALY gained thresholds. The intervals were insensitive to the findings at screening colonoscopy. Conclusion. Follow-up colonoscopy is cost-effective following screening at age 50 years but not if screening occurs later. Following screening at age 50 years, the optimal follow-up interval is close to the currently recommended 10 years for an average risk screening but does not vary by colonoscopy result.

scholarly journals Colorectal Cancer Screening: Video-Reviewed Flexible Sigmoidoscopy by Nurse Endoscopists — A Canadian Community-Based Perspective

2001 ◽  
Vol 15 (7) ◽  
pp. 441-445 ◽  
Author(s):  
TF Shapero ◽  
PE Alexander ◽  
J Hoover ◽  
E Burgis ◽  
R Schabas
Keyword(s):  
Colorectal Cancer ◽  
Flexible Sigmoidoscopy ◽  
Screening Program ◽  
Early Stage ◽  
Community Setting ◽  
Average Risk ◽  
Crc Screening ◽  
Asymptomatic Patients ◽  
Incident Cancer

BACKGROUND: Colorectal cancer (CRC) is the third most common incident cancer and the second most fatal cancer in Canada. Flexible sigmoidoscopy (FS) is one of the modalities under consideration for CRC screening. The present series reports on a screening program of FS performed by nonphysician endoscopists in a Canadian community setting, with video review of procedures by physicians and recommendation of follow-up colonoscopy where polyps are identified.RESULTS: Five hundred twenty-five, average-risk, asymptomatic patients were examined. After exclusion of inappropriate referrals, 488 remained for analysis. The duration and extent of examination were comparable with those of previous studies elsewhere. Compliance with suggested follow-up was 97.3%. Polyps were identified at FS in 15.4% of examinees. In 8.2% of patients, the polyps were neoplastic at subsequent histology. Four malignant lesions were detected, all at an early stage. There were no complications of FS.INTERPRETATION: This report shows that FS can be carried out safely and effectively by nonphysician personnel in a community setting in Canada. The manpower cost for nonphysician operators is considerably less than that for specialist physician endoscopists. This approach deserves consideration in cost effectiveness analyses of CRC screening.

scholarly journals 995 Clinical Outcomes Following Incomplete Colonoscopy

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K S Khan ◽  
C McCulloch
Keyword(s):  
Colorectal Cancer ◽  
Clinical Outcome ◽  
Incomplete Data ◽  
Significant Risk ◽  
Exclusion Criteria ◽  
Data Set ◽  
Incomplete Colonoscopy ◽  
Increased Risk ◽  
Repeat Colonoscopy

Abstract Introduction Following incomplete colonoscopy (IC) it is reported that there is up to five-fold increased risk of colorectal cancer. Our aim was to determine the final clinical outcome for patients with a prior IC. Method A multi-centre retrospective observational study involving three endoscopy units. All consecutive patients having colonoscopy from over 18 months were analysed. Exclusion criteria included IC was due to obstructing cancer, follow up was not performed due to non-attendance at clinic or investigation and incomplete data set. Electronic notes were analysed to determine patient’s final clinical outcome. All patients were followed up for minimum of six months. Results Of the 8,490 colonoscopies, 733 (8.6%) were IC. 86 (11.7%) were excluded. Of the 647 included, 469 (72.4%) were females and 473 (73.1%) has further colonic investigations. Secondary investigations were: CT colonography 169 (35.7%), repeat colonoscopy 161 (34.0%), barium enema 95 (20.1%) and others 48 (10.1%). The repeat colonoscopy group achieved a complete colonoscopy in 111 (68.9%) patients. For those who had further investigations 15 (3.2%) had colorectal cancer and 12 (2.5%) has polyps ≥1cm. Conclusions There is significant risk of missing colorectal malignancy and large polyps following IC. Further colonic investigations should be carried out in this cohort of patients.

Postcolonoscopy colorectal cancers in average-risk Korean subjects with a normal initial colonoscopy.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 526-526
Author(s):  
Han Hee Lee ◽  
Hyun Ho Choi ◽  
Chun-Hyun Lim ◽  
Hyung-Keun Kim ◽  
Sung Soo Kim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Advanced Adenoma ◽  
Colorectal Cancers ◽  
Average Risk ◽  
Asian Countries ◽  
Technical Improvement ◽  
Advanced Neoplasia ◽  
Adenoma Detection ◽  
Advanced Adenomas

526 Background: There are relatively few studies regarding the incidence of postcolonoscopy colorectal cancer (PCCRC) in Asian countries. We evaluated the characteristics of PCCRC in average-risk Korean subjects. Methods: This study included subjects who were ≥ 50 years of age and had undergone a first completed colonoscopy between January 2001 and December 2004, at which no baseline adenoma had been detected, followed by a second colonoscopy 1–5 years later. The incidence and characteristics of advanced neoplasia in these subjects were assessed. Results: A total of 343 subjects underwent follow-up colonoscopy within 5 years. Seventy-three (21.3%) subjects were found to have at least one adenoma upon follow-up colonoscopy. Advanced adenoma was found in eight (2.3%) subjects, and non-advanced adenomas were found in 65 (19.0%). Five patients (1.5%) were diagnosed with invasive CRC following a normal colonoscopy. The putative reason for the PCCRCs was missed lesions in two (40.0%) and new cancer in three (60.0%) cases. Conclusions: The risk of advanced neoplasia (including PCCRCs) within 5 years after a normal baseline colonoscopy in our cohort was not low. Considering that 40% of PCCRCs were attributable to missed lesions, our results emphasize the need for technical improvement of colonoscopic examinations to improve adenoma detection.

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