The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations

BackgroundThe UK guideline recommends 3-yearly surveillance for patients with intermediate-risk (IR) adenomas. No study has examined whether or not this group has heterogeneity in surveillance needs.ObjectivesTo examine the effect of surveillance on colorectal cancer (CRC) incidence; assess heterogeneity in risk; and identify the optimum frequency of surveillance, the psychological impact of surveillance, and the cost-effectiveness of alternative follow-up strategies.DesignRetrospective multicentre cohort study.SettingRoutine endoscopy and pathology data from 17 UK hospitals (n = 11,944), and a screening data set comprising three pooled cohorts (n = 2352), followed up using cancer registries.SubjectsPatients with IR adenoma(s) (three or four small adenomas or one or two large adenomas).Primary outcomesAdvanced adenoma (AA) and CRC detected at follow-up visits, and CRC incidence after baseline and first follow-up.MethodsThe effects of surveillance on long-term CRC incidence and of interval length on findings at follow-up were examined using proportional hazards and logistic regression, adjusting for patient, procedural and polyp characteristics. Lower-intermediate-risk (LIR) subgroups and higher-intermediate-risk (HIR) subgroups were defined, based on predictors of CRC risk. A model-based cost–utility analysis compared 13 surveillance strategies. Between-group analyses of variance were used to test for differences in bowel cancer worry between screening outcome groups (n = 35,700). A limitation of using routine hospital data is the potential for missed examinations and underestimation of the effect of interval and surveillance.ResultsIn the hospital data set, 168 CRCs occurred during 81,442 person-years (pys) of follow-up [206 per 100,000 pys, 95% confidence interval (CI) 177 to 240 pys]. One surveillance significantly lowered CRC incidence, both overall [hazard ratio (HR) 0.51, 95% CI 0.34 to 0.77] and in the HIR subgroup (n = 9265; HR 0.50, 95% CI 0.34 to 0.76). In the LIR subgroup (n = 2679) the benefit of surveillance was less clear (HR 0.62, 95% CI 0.16 to 2.43). Additional surveillance lowered CRC risk in the HIR subgroup by a further 15% (HR 0.36, 95% CI 0.20 to 0.62). The odds of detecting AA and CRC at first follow-up (FUV1) increased by 18% [odds ratio (OR) 1.18, 95% CI 1.12 to 1.24] and 32% (OR 1.32, 95% CI 1.20 to 1.46) per year increase in interval, respectively, and the odds of advanced neoplasia at second follow-up increased by 22% (OR 1.22, 95% CI 1.09 to 1.36), after adjustment. Detection rates of AA and CRC remained below 10% and 1%, respectively, with intervals to 3 years. In the screening data set, 32 CRCs occurred during 25,745 pys of follow-up (124 per 100,000 pys, 95% CI 88 to 176 pys). One follow-up conferred a significant 73% reduction in CRC incidence (HR 0.27, 95% CI 0.10 to 0.71). Owing to the small number of end points in this data set, no other outcome was significant. Although post-screening bowel cancer worry was higher in people who were offered surveillance, worry was due to polyp detection rather than surveillance. The economic evaluation, using data from the hospital data set, suggested that 3-yearly colonoscopic surveillance without an age cut-off would produce the greatest health gain.ConclusionsA single surveillance benefited all IR patients by lowering their CRC risk. We identified a higher-risk subgroup that benefited from further surveillance, and a lower-risk subgroup that may require only one follow-up. A surveillance interval of 3 years seems suitable for most IR patients. These findings should be validated in other studies to confirm whether or not one surveillance visit provides adequate protection for the lower-risk subgroup of intermediate-risk patients.Study registrationCurrent Controlled Trials ISRCTN15213649.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Heterogeneity in colorectal cancer incidence among people recommended 3-yearly surveillance post-polypectomy: a validation study

Endoscopy ◽

10.1055/a-1217-0155 ◽

2020 ◽

Author(s):

Emma C. Robbins ◽

Kate Wooldrage ◽

Iain Stenson ◽

Kevin Pack ◽

Stephen Duffy ◽

...

Keyword(s):

Colorectal Cancer ◽

Lower Risk ◽

Cox Regression ◽

Risk Groups ◽

Baseline Risk ◽

Intermediate Risk ◽

Hospital Data ◽

Crc Screening ◽

Increased Risk ◽

The Uk

Abstract Background Colonoscopy surveillance is recommended for patients at increased risk of colorectal cancer (CRC) following adenoma removal. Low-, intermediate-, and high-risk groups are defined by baseline adenoma characteristics. We previously examined intermediate-risk patients from hospital data and identified a higher-risk subgroup who benefited from surveillance and a lower-risk subgroup who may not require surveillance. This study explored whether these findings apply in individuals undergoing CRC screening. Methods This retrospective study used data from the UK Flexible Sigmoidoscopy Screening Trial (UKFSST), English CRC screening pilot (ECP), and US Kaiser Permanente CRC prevention program (KPCP). Screening participants (50 – 74 years) classified as intermediate-risk at baseline colonoscopy were included. CRC data were available through 2006 (KPCP) or 2014 (UKFSST, ECP). Lower- and higher-risk subgroups were defined using our previously identified baseline risk factors: higher-risk participants had incomplete colonoscopies, poor bowel preparation, adenomas ≥ 20 mm or with high-grade dysplasia, or proximal polyps. We compared CRC incidence in these subgroups and in the presence vs. absence of surveillance using Cox regression. Results Of 2291 intermediate-risk participants, 45 % were classified as higher risk. Median follow-up was 11.8 years. CRC incidence was higher in the higher-risk than lower-risk subgroup (hazard ratio [HR] 2.08, 95 % confidence interval [CI] 1.07 – 4.06). Surveillance reduced CRC incidence in higher-risk participants (HR 0.35, 95 %CI 0.14 – 0.86) but not statistically significantly so in lower-risk participants (HR 0.41, 95 %CI 0.12 – 1.38). Conclusion As previously demonstrated for hospital patients, screening participants classified as intermediate risk comprised two risk subgroups. Surveillance clearly benefited the higher-risk subgroup.

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Experiences of recovery from colorectal cancer surgery after hospital discharge among the oldest old: A qualitative study

Nordic Journal of Nursing Research ◽

10.1177/2057158521994451 ◽

2021 ◽

pp. 205715852199445

Author(s):

Kristina Sundt Eriksen ◽

Sissel Iren Eikeland Husebø ◽

Hartwig Kørner ◽

Kirsten Lode

Keyword(s):

Colorectal Cancer ◽

Thematic Analysis ◽

Oldest Old ◽

Healthcare Services ◽

Hospital Data ◽

Colorectal Cancer Surgery ◽

Discharge From Hospital ◽

Depth Interviews ◽

Inductive Thematic Analysis

Colorectal cancer affects a large number of people aged ≥80 years. Little is known about how they manage after discharge from hospital. The aim of this study was to explore the experiences of individuals aged ≥80 years recovering from surgery for colorectal cancer, and the challenges they may encounter after discharge from hospital. Data were collected between January and March 2016 through in-depth interviews with ten participants approximately one month after surgery. Inductive thematic analysis was employed to analyse the data. The COREQ checklist was used in reporting this study. Two themes were identified: Managing the recovery from CRC surgery, and Insufficient follow-up from the healthcare services after CRC surgery. The findings indicate that older people treated for colorectal cancer manage surprisingly well after discharge despite challenges in their recovery; however, there are seemingly areas of improvement in their follow-up healthcare.

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Prevalence of colorectal cancer and advanced adenoma in patients with acute diverticulitis: implications for follow-up colonoscopy

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.08.044 ◽

2020 ◽

Vol 91 (3) ◽

pp. 634-640 ◽

Cited By ~ 4

Author(s):

Shahrzad Tehranian ◽

Matthew Klinge ◽

Melissa Saul ◽

Michele Morris ◽

Brenda Diergaarde ◽

...

Keyword(s):

Colorectal Cancer ◽

Acute Diverticulitis ◽

Advanced Adenoma

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Walking Time, Sports Activity, Job Type, and Body Posture During Work in Relation to Incident Colorectal Cancer: The JACC Prospective Cohort Study

10.21203/rs.3.rs-423828/v1 ◽

2021 ◽

Author(s):

Ehab Salah Eshak ◽

Hiroyuki Noda ◽

Akiko Tamakoshi ◽

Hiroyasu Iso

Keyword(s):

Colorectal Cancer ◽

Lower Risk ◽

Leisure Time ◽

Office Workers ◽

Sports Activity ◽

Japanese Men ◽

Job Type ◽

Incident Cases ◽

Walking Time

Abstract Purpose An inverse association between physical activity and colorectal cancer (CRC) was suggested. We aimed to assess the specific and combined effects of leisure-time and occupational physical activities on CRC risk among Japanese adults. Methods Using Cox proportional hazard models, we tested whether walking time, sports activity, body posture during work, and job type– or the combination of these variables – were associated with CRC incidence during 17 years of follow-up (1990–2009) in a prospective cohort of 26,897 Japanese men and women aged 40–79 years. Results During the follow-up period, 423 incident cases of CRC (267 colon and 156 rectum cancer) were ascertained. Time spent walking showed a dose-response inverse relationship with CRC risk (p-trend = 0.053). Manual labor was associated with lower CRC risk when compared to office work; HR (95%CI) = 0.75 (0.57–0.98) for colorectal cancer and 0.69 (0.48–0.97) for colon cancer. Compared to sitting, moving during work tended to be inversely associated with rectal cancer risk, especially after censoring early incident cases within 3 years after baseline; HR (95% CI) = 0.63 (0.40–0.99). Combining leisure-time walking with job type suggested mutual and synergistic benefits (p-interaction < 0.05). Compared to office workers walking < 1h/d, non-office workers walking < 1h/d had a 39% lower risk, office workers walking ≥ 1h/d had a 52% lower risk, while non-office workers walking ≥ 1h/d had a 40% lower risk of developing colon cancer. Conclusions The time spent walking, job type and posture during work were independently and additively associated with reduced incident CRC risk among Japanese men and women.

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995 Clinical Outcomes Following Incomplete Colonoscopy

British Journal of Surgery ◽

10.1093/bjs/znab134.343 ◽

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.

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Surveillance of Monoclonal Gammopathy of Undetermined Significance: A Proposed Change

Blood ◽

10.1182/blood-2021-144885 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1906-1906

Author(s):

Hollie Elise Sheffield ◽

Yu-Min Shen ◽

Nivan Chowattukunnel ◽

Waqas Haque

Keyword(s):

Risk Stratification ◽

Lower Risk ◽

Monoclonal Gammopathy ◽

Risk Group ◽

Risk Groups ◽

Bone Lesions ◽

Evidence Based ◽

Intermediate Risk ◽

Undetermined Significance

Abstract Background: Monoclonal gammopathy of undetermined significance (MGUS) is a diagnosis that is often incidentally made after a serum protein electrophoresis (SPEP) is ordered as part of the evaluation for multiple nonspecific symptoms and is often ordered by non-hematologists. Currently, there is a lack of guidance regarding the extent of evaluation and follow-up required for these patients. Objective: Determine whether the risk stratification of the abnormal SPEP predicted progression to multiple myeloma (MM) or other lymphoplasmacytic malignancies (LPM) and could act as a guideline for appropriate follow-up in attempts to provide evidence-based, higher value care. Design: A retrospective review was performed of patients referred to the county hematology clinic for an abnormal SPEP from 2012 to 2019. The SPEP results were then risk-stratified and individual patient charts were reviewed to determine the symptomatology present at the time it was ordered, as well as the clinical course of the patients over time. Main Measures: Patients were stratified into low, low-intermediate, high-intermediate, and high risk groups for progression to MM based on the Mayo Clinic criteria. Additional information was also analyzed including the number of SPEP tests per patient, the indication stated for ordering the SPEP, and the presence of symptoms that are associated with MM at the time the SPEP was ordered, including anemia, renal failure, hypercalcemia, and bone lesions (commonly known as "CRAB symptoms"). Results: We abstracted data from 436 patients referred to the hematology clinic associated with a large county hospital system for an abnormal SPEP. The most common documented reasons for SPEP testing were increased creatinine (35%), protein gap (12%), and decreased hemoglobin (11%). Of these patients, 24 (5.5%) developed MM, 19 of whom were stratified into the high-intermediate risk group. More than a thousand SPEP results were obtained in the low and low-intermediate risk groups with only 5 patients diagnosed with MM. In the high-intermediate and low-intermediate risk groups, between 2-3 SPEP tests were performed prior to making the diagnosis of MM. In the low risk group, 6 SPEP tests were performed prior to reaching the MM diagnosis. Among the 5 patients in the low and low-intermediate risk groups who developed MM, all 5 had one or more of the CRAB symptoms at the time of the initial SPEP. Conclusion: Of the patients with MGUS who progressed to MM, approximately 80% were in the high-intermediate risk group. Of the remaining patients who progressed to MM from the lower risk groups, all had one or more of the previously mentioned CRAB symptoms, a higher percentage compared to the low and low-intermediate risk groups overall. In the absence of symptomatic disease, there is insufficient evidence to support serial SPEP testing in the lower risk patients. The use of evidence-based risk stratification may minimize unnecessary testing and hematology referrals while resulting in significant cost-savings and higher value care. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Ruxolitinib In Myelofibrosis (MF) Patients Through Compassionate Use Program (CUP). Argentinian Experience

Blood ◽

10.1182/blood.v122.21.5247.5247 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5247-5247

Author(s):

Mauricio A Alzate ◽

María J Mela Osorio ◽

Paula Barreyro ◽

Alicia Inés Enrico ◽

Ana García de Labanca ◽

...

Keyword(s):

Board Of Directors ◽

Lower Risk ◽

Risk Group ◽

Eastern Cooperative Oncology Group ◽

Myeloproliferative Neoplasm ◽

Costal Margin ◽

Spleen Size ◽

Advisory Committees ◽

Data Set

Abstract Introduction MF is a myeloproliferative neoplasm characterized by bone marrow fibrosis, splenomegaly, cytopenias and constitutional symptoms. Since the identification of JAK2V617F mutation and development of anti JAK molecules, the course of the disease has changed. Ruxolitinib is a JAK1 and JAK2 inhibitor recently approved for patients (pts) with primary and secondary MF. In Argentina, pts could access the ruxolitinib through CUP. Analysis of this multicenter protocol provides a preliminary data set, follow up and efficacy results. Objectives To assess the efficacy (reduction in spleen size/improvement in constitutional symptoms) and toxicity. To investigate risk groups modifications during follow-up. Methods In Argentina, 36 pts with myelofibrosis, including primary MF (PMF) and post polycythemia vera (PPV) received ruxolitinib through CUP regardless of JAK2 mutational status. Study period: September 2011 to June 2013. The participating physicians provided information of the disease characteristics by completing a data form. Splenomegaly was evaluated by physical exam, and constitutional symptoms were categorized as present or absent. Retrospective analysis was performed based on data at baseline (n 36), after 3 months (n 30), 6 months (n 24) and 12 months (n 14). Results Median follow-up is 10 months (1-20). The median age is 65 years (30-79), 64% were men and 36% women. There were 72% positive for the JAK2 V617F mutation, 69% had PMF and 31% Post-PV. At admission 89% of pts had received ≥1 lines of therapy for MF prior to ruxolitinib: hydroxyurea 77%, thalidomide 26%, erythropoietin 23%, others: corticosteroids, interferon, anagrelide, danazol, busulfan, splenic radiation, cytarabine, and 6-mercaptopurine. The distribution of risk category according to DIPSS was: 61% high, 19% Intermediate 2, 17% Intermediate 1, and 3% low. Median value for spleen size was 15 cm (4-33) below the costal margin. Constitutional symptoms were present in 71% of the patients and 33% were transfusion dependent. ECOG (Eastern Cooperative Oncology Group) was zero 28%, one 44%, two 22%, three 3%, and four 3%. The median hemoglobin, leucocytes and platelets was 10 g/dl (4.8-15.2); 13, 4 x 109/L (3.6-64) and 217 x 109/L (75-850), respectively. Peripheral blood blasts ≥ 1% in 44% of pts. Ruxolitinib therapy was initiated at 40 mg/d in 16 pts (50%), 30 mg/day in 9 pts (28%), and at a lower dose in the minority of pts. The median value for spleen size at 3, 6 and 12 months was 10, 8 and 6.5 cm, representing decrease of 20%, 41% and 42% from baseline, respectively (fig 1.). In 13 of 29 pts (45%) spleen size decreased ≥ 50% in 3 months. Constitutional symptoms not present at 3, 6 and 12 months in 79%, 100% and 87% of pts, respectively. Improvement in ECOG class was noted in 73%, 69 % and 73% at the above mentioned time points, respectively. Persistence of transfusion dependence at 3, 6 and 12 months was seen in 33, 24 and 27% of the patients. Hemoglobin median levels during treatment (g/dL): at baseline 10.1, at 3 months 8.5, at 6 months 9.7, and at 12 months 9.5. During follow-up, 27% pts shifted to a lower risk group, 2 pts (7%) to a higher group due to worsening anemia, and 67% did not change its category. Hematologic adverse events (AE) were anemia and thrombocytopenia in 8 pts (Grade 1 and Grade 3 according to CTCAE v4.0), 31% of pts required dose adjustment. There were no suspensions of medication because of cytopenia. Others AE > 10% were: headache, musculoskeletal pain, and diarrhea (<G3). Treatment was discontinued in 7 pts (MF progression n= 2, tuberculosis n=1, death n=4 non related to ruxolitinib). Conclusion Ruxolitinib is an effective therapy that reduced spleen size and improved constitutional symptoms with an acceptable toxicity profile in this group of pts. During follow up at 12 months, a quarter of pts shifted to a lower risk group. Our data is consistent with previous reports Disclosures: Barreyro: GSK: Employment. Enrico:Bristol Myers Squibb: Speakers Bureau; Pfizer: Membership on an entity’s Board of Directors or advisory committees; Novartis: Membership on an entity’s Board of Directors or advisory committees. Lanari Zubiaur:Novartis: Membership on an entity’s Board of Directors or advisory committees. Pavlovsky:Novartis: Consultancy. Sackmann:Novartis: Membership on an entity’s Board of Directors or advisory committees. Bengió:Novartis: Member advisory Board Myelofibrosis Other.

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

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.526 ◽

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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Association of aspirin use with improved 5-year survival in colorectal cancer patients with PIK3CA mutation.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.3644 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 3644-3644

Author(s):

Nishi Kothari ◽

Timothy Joseph Yeatman ◽

Kate Fisher ◽

Michael J. Schell ◽

Richard D. Kim

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Pik3ca Mutation ◽

Stage Iv ◽

Pi3k Pathway ◽

Data Set ◽

Pik3ca Mutations ◽

Colorectal Cancer Patients ◽

Related Mortality

3644 Background: Recent work has shown an association between longer survival and aspirin use in colorectal cancer (CRC) patients with mutated PIK3CA. It has been hypothesized that this survival advantage could occur via blocking the PI3K pathway and allowing apoptosis of mutated cancer cells. The goal of this work is examine the use of aspirin and outcome in CRC patients with PI3KCA mutation. Methods: PIK3CA mutation status was assessed in paraffin-embedded tumor samples from 471 CRC patients between 1998-2010. PIK3CA mutation was assessed by exome sequencing using an Illumina Next Generation (NGS) platform with 50-100X coverage on all patients. The BWA/GATK pipeline was used to identify variants and indels. Because matched normal samples were not available for comparison to identify somatic mutations, filtering of normal variants was performed using 1000 Genomes. The usage of aspirin was collected retrospectively with electronic chart review. Results: Out of 471 patients, 73 were found to have unique PIK3CA mutations by NGS (15.4%). The most common mutations were found at codon 9 (38%) and codon 20 (21%). Patients had a median follow up of 47 months. Initial stage at diagnosis for PIK3CA mutants were as follows: 11 pts were stage I, 31 pts were stage II, 24 pts were stage III and 16 patients were stage IV. Of patients who died, those taking ASA had a 5% cancer related mortality compared to 23% cancer related mortality in non-ASA users. In contrast, the non-cancer related mortality was 25% in ASA users and only 8% in non-ASA users. Cancer specific rates for five year survival were 90% in the ASA group and 57% in the non-ASA group for all stages. In stage IV patients, there was 80% five year survival in the ASA users and 32% in the non-ASA group. Conclusions: There was a trend toward improvement in five year survival for colorectal cancer patients with PIK3CA mutations who used ASA. This trend persisted even in stage IV patients. Notably, non-cancer related deaths were higher in the ASA users, most likely secondary to medical comorbidities that necessitated ASA use. As follow up continues and this data set matures, future work will focus on validating these preliminary results and relating specific PIK3CA mutations to ASA response.

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The Psychological Impact of Being Offered Surveillance Colonoscopy following Attendance at Colorectal Screening Using Flexible Sigmoidoscopy

Journal of Medical Screening ◽

10.1258/jms.2009.009041 ◽

2009 ◽

Vol 16 (3) ◽

pp. 124-130 ◽

Cited By ~ 5

Author(s):

Anne Miles ◽

Wendy S Atkin ◽

Ines Kralj-Hans ◽

Jane Wardle

Keyword(s):

Lower Risk ◽

Flexible Sigmoidoscopy ◽

Psychological Impact ◽

Bowel Cancer ◽

The Other ◽

Generalized Anxiety ◽

Cancer Worry ◽

Colonoscopic Surveillance ◽

Bowel Symptoms ◽

Gp Visits

Objectives To examine the psychological impact of being assigned to colonoscopic surveillance following detection of adenomatous polyps at flexible sigmoidoscopy (FS) screening. Setting Participants invited for screening in 12 of the 14 study centres in the UK FS Trial. Methods A postal survey following FS screening assessed bowel cancer worry, psychological distress, generalized anxiety, bowel symptoms, general practitioner (GP) visits, positive emotional consequences of screening, and reassurance among people with no polyps ( n = 26,573), lower-risk polyps removed at FS ( n = 7401) and higher-risk polyps who underwent colonoscopy and were either assigned to colonoscopic surveillance ( n = 1543) or discharged ( n = 183). A sub-sample ( n = 6389) also completed a questionnaire prior to screening attendance that measured bowel cancer worry, generalized anxiety, bowel symptoms and GP visits, making it possible to examine longitudinal changes in this group. Results People offered surveillance reported lower psychological distress and anxiety than those with either no polyps or lower-risk polyps. The surveillance group also reported more positive emotional benefits of screening than the other outcome groups. Post-screening bowel cancer worry and bowel symptoms were higher in people assigned to surveillance, but both declined over time, reaching levels observed in either one or both of the other two groups found to have polyps, suggesting these results were a consequence of polyp detection rather than surveillance per se. Few differences were observed between the group assigned surveillance and the group discharged following colonoscopy. Conclusion The results of the current study are broadly reassuring and indicate that referral for colonoscopic surveillance is not associated with adverse psychological consequences.

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