This data suggests clinicians should not rely on self-reports from their patients about either their need or the proper interval for a repeat surveillance colonoscopy.
A study published in the Journal of Gastroenterology & Digestive Systems found that there is a lack of knowledge among patients with biopsy proven advanced colorectal polyps regarding the need for repeat colonoscopy as well as the proper surveillance interval.1
Overall, the researchers noted that this data suggests clinicians should not rely on self-reports from their patients about either their need or the proper interval for a repeat surveillance colonoscopy.
“For patients with biopsy proven advanced colorectal polyps, the interval for colonoscopy is about 3 years. Our data raise a challenge for us to rely on more objective data than self-reports,” co-author Lawrence Fiedler, MD, a gastroenterologist and an affiliate associate professor in Florida Atlantic University’s (FAU’s) Schmidt College of Medicine, said in a press release.2 “Clinicians should have the ability and willingness to share their objective findings with all clinical colleagues involved in the care of the patient. These efforts should also include younger patients such as Chadwick Boseman who recently died of colon cancer at age 43.”
Utilizing questionnaire data from 55 gastroenterologist practices, researchers identified patients with biopsy proven advanced colorectal polyps. Over a 4-year period from 2013 to 2017, 249 consecutive patients aged 40 to 95 years from relatively affluent communities in south Florida who had biopsy proven advanced colorectal polyps were identified.
With a total of 84 eligible and willing participants who provided complete data, 24 (28.6%) individuals were reportedly unaware of either the need for a repeat colonoscopy or the proper surveillance interval. Of these participants, 14 (16.6%) were unaware of the generally recommended 3-year interval to obtain a follow up surveillance colonoscopy. In addition, 10 participants (12.0%) were not aware that they required a follow up surveillance colonoscopy.
“Data from our study pose clinical and public health challenges to reduce the rates of recurrences of colorectal polyps as well as subsequent risks of colorectal cancer in these high-risk patients,” senior author Charles H. Hennekens, MD, DrPH, first Sir Richard Doll Professor and senior academic advisor in FAU’s Schmidt College of Medicine, said in the release. “More than 90% of patients diagnosed with colorectal cancer are 50 years or older. The major risk factors for colorectal cancer are similar to those for heart attacks and stroke and include overweight and obesity, type 2 diabetes, as well as physical inactivity.”
In addition to relying on more objective data rather than self-reports, researchers suggested clinicians will probably need to rely on robust recall protocols and systems which are, in many cases, already in place. This would ensure that all patients receive regular and timely follow up care reminders. Further, for high-risk patients, the investigators recommended that clinicians also recognize that their patients at high-risk of colorectal cancer are also at high-risk for myocardial infarction and stroke. These patients therefore require multifactorial interventions, such as therapeutic lifestyle changes as well as adjunctive drug therapies of proven benefit.
“In summary, the ability to address the clinical and public health challenges posed by these data would reduce premature and avoidable morbidity and mortality in all their high-risk patients with biopsy proven advanced colorectal polyps from future recurrences as well as the development of colorectal cancer,” the authors concluded.
1. Rothschild E, Fiedler B, Fiedler L, et al. Lack of Knowledge about Colonoscopy in High Risk Patients: Clinical and Public Health Challenges. Journal of Gastroenterology & Digestive Systems. http://www.opastonline.com/storage/2020/06/lack-of-knowledge-about-colonoscopy-in-high-risk-patients-clinical-and-public-health-challenges-jgds-20.pdf
2. HIGH-RISK PATIENTS FOR COLORECTAL CANCER LACK COLONOSCOPY KNOWLEDGE [news release]. FAU. Published September 14, 2020. Accessed September 21, 2020. http://www.fau.edu/newsdesk/articles/colorectal-cancer-study.php