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Atarere J, Naqvi H, Haas C, Adewunmi C, Bandaru S, Allamneni R, Ugonabo O, Egbo O, Umoren M, Kanth P. Applicability of Online Chat-Based Artificial Intelligence Models to Colorectal Cancer Screening. Dig Dis Sci 2024; 69:791-797. [PMID: 38267726 DOI: 10.1007/s10620-024-08274-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Over the past year, studies have shown potential in the applicability of ChatGPT in various medical specialties including cardiology and oncology. However, the application of ChatGPT and other online chat-based AI models to patient education and patient-physician communication on colorectal cancer screening has not been critically evaluated which is what we aimed to do in this study. METHODS We posed 15 questions on important colorectal cancer screening concepts and 5 common questions asked by patients to the 3 most commonly used freely available artificial intelligence (AI) models. The responses provided by the AI models were graded for appropriateness and reliability using American College of Gastroenterology guidelines. The responses to each question provided by an AI model were graded as reliably appropriate (RA), reliably inappropriate (RI) and unreliable. Grader assessments were validated by the joint probability of agreement for two raters. RESULTS ChatGPT and YouChat™ provided RA responses to the questions posed more often than BingChat. There were two questions that > 1 AI model provided unreliable responses to. ChatGPT did not provide references. BingChat misinterpreted some of the information it referenced. The age of CRC screening provided by YouChat™ was not consistently up-to-date. Inter-rater reliability for 2 raters was 89.2%. CONCLUSION Most responses provided by AI models on CRC screening were appropriate. Some limitations exist in their ability to correctly interpret medical literature and provide updated information in answering queries. Patients should consult their physicians for context on the recommendations made by these AI models.
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Affiliation(s)
- Joseph Atarere
- Department of Medicine, MedStar Health, 201 East University Pkwy, Baltimore, MD, 21218, USA.
- Department of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Haider Naqvi
- Department of Medicine, MedStar Health, 201 East University Pkwy, Baltimore, MD, 21218, USA
| | - Christopher Haas
- Department of Medicine, MedStar Health, 201 East University Pkwy, Baltimore, MD, 21218, USA
| | - Comfort Adewunmi
- Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sumanth Bandaru
- Department of Medicine, MedStar Health, 201 East University Pkwy, Baltimore, MD, 21218, USA
| | - Rakesh Allamneni
- Department of Medicine, MedStar Health, 201 East University Pkwy, Baltimore, MD, 21218, USA
| | - Onyinye Ugonabo
- Department of Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Olachi Egbo
- Department of Medicine, Aurora Medical Center, Oshkosh, WI, USA
| | - Mfoniso Umoren
- Division of Gastroenterology, Georgetown University Hospital, Washington, DC, USA
| | - Priyanka Kanth
- Division of Gastroenterology, Georgetown University Hospital, Washington, DC, USA
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Letendre A, Khan M, Bartel R, Chiang B, James A, Shewchuk B, Kima J, Macphail M, Vaska M, Schwann M, Yang H, Kopciuk KA. Creation of a Métis-Specific Instrument for Cancer Screening: A Scoping Review of Cancer-Screening Programs and Instruments. Curr Oncol 2023; 30:9849-9859. [PMID: 37999135 PMCID: PMC10670396 DOI: 10.3390/curroncol30110715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
Understanding the barriers to and facilitators of cancer screening programs among Indigenous populations remains limited. In the spirit of mutual respect, this co-led, collaborative project was carried out between the Métis Nation of Alberta and Screening Programs from Alberta Health Services (AHS). This scoping review assessed the cancer screening literature for available questionnaires and then identified themes and suitable questions for a Métis-specific cancer screening questionnaire. Literature searches on cervical, breast, and colorectal cancer screening programs and related concepts were conducted in electronic databases, including the Native Health Database, MEDLINE (Ovid), PsycINFO, PubMed, PubMed Central, CINAHL, MEDLINE (Ebsco), Psychology & Behavioral Sciences Collection, and Web of Science. Grey literature was collected from AHS Insite, Open Archives Initiative repository, American Society of Clinical Oncology, European Society of Medical Oncology, Google, and Google Scholar. 135 articles were screened based on the eligibility criteria with 114 articles selected, including 14 Indigenous-specific ones. Knowledge, attitude, belief, behaviour, barrier, and facilitator themes emerged from the review, but no Métis-specific cancer screening instruments were found. Thus, one was developed using existing cancer screening instruments, with additional questions created by the project team. A survey of the Métis population in Alberta will use this questionnaire and provide data to address the burden of cancer among Métis people.
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Affiliation(s)
- Angeline Letendre
- Cancer Prevention & Screening Innovation, Provincial, Population and Public Health, Alberta Health Services, Edmonton, AB T5J 3E4, Canada;
| | - Momtafin Khan
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (M.K.)
| | - Reagan Bartel
- Métis Nation of Alberta, Edmonton, AB T5G 0X5, Canada; (R.B. & A.J. & J.K.)
| | - Bonnie Chiang
- Screening Programs, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (B.C.); (M.S.); (H.Y.)
| | - Ashton James
- Métis Nation of Alberta, Edmonton, AB T5G 0X5, Canada; (R.B. & A.J. & J.K.)
| | - Brittany Shewchuk
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (M.K.)
| | - June Kima
- Métis Nation of Alberta, Edmonton, AB T5G 0X5, Canada; (R.B. & A.J. & J.K.)
| | - Meghan Macphail
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada;
| | - Marcus Vaska
- Knowledge Resource Service, Alberta Health Services, Calgary, AB T2N 4N2, Canada;
| | - Monica Schwann
- Screening Programs, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (B.C.); (M.S.); (H.Y.)
| | - Huiming Yang
- Screening Programs, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (B.C.); (M.S.); (H.Y.)
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada;
| | - Karen A. Kopciuk
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (M.K.)
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada;
- Departments of Oncology and Mathematics and Statistics, University of Calgary, Calgary, AB T2N 1N4, Canada
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Gu XF, Xu HF, Liu Y, Li L, Yu YQ, Zhang X, Wang XH, Wang WJ, Du LB, Duan SX, Cao HL, Zhao YQ, Liu YY, Huang JX, Cao J, Fan YP, Feng CY, Lian XM, Du JC, Rezhake R, Ma L, Qiao YL. Involvement in treatment decision-making and self-reported efficacy among patients with advanced colorectal cancer: a nationwide multi-center cross-sectional study. Front Oncol 2023; 13:1168078. [PMID: 37564928 PMCID: PMC10411882 DOI: 10.3389/fonc.2023.1168078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/22/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction This cross-sectional study evaluated the involvement of patients with advanced colorectal cancer (CRC) in treatment decision-making, assessed the treatment efficacy according to their self-reports, and investigated the influencing factors. Methods Patients with advanced CRC were recruited from 19 hospitals from March 2020 to March 2021 by a multi-stage multi-level sampling method. A self-designed questionnaire was used to collect demographic and clinical characteristics, involvement of CRC patients in treatment decision-making, treatment methods, and self-reported efficacy. Univariate and unordered multinomial logistic regression analyses were used to evaluate the factors affecting the involvement in treatment decision-making and self-reported efficacy. Results We enrolled 4533 patients with advanced CRC. The average age at diagnosis was 58.7 ± 11.8 years. For the treatment method, 32.4% of patients received surgery combined with chemotherapy, 13.1% of patients underwent surgery combined with chemotherapy and targeted therapy, and 9.7% of patients were treated with surgery alone. For treatment decision-making, 7.0% of patients were solely responsible for decision-making, 47.0% of patients shared treatment decision-making with family members, 19.0% of patients had family members solely responsible for treatment decision-making, and 27.0% of patients had their physicians solely responsible for treatment decision-making. Gender, age, education level, family income, marital status, treatment cost, hospital type, and treatment method were significantly associated with the involvement of patients in treatment decision-making. A total of 3824 patients submitted self-reported efficacy evaluations during treatment. The percentage of patients with good self-reported efficacy was 76.5% (for patients treated for the first time), 61.7% (for patients treated for the second time), and 43.2% (for patients treated after recurrence and metastasis), respectively. Occupation, education level, average annual family income, place of residence, time since cancer diagnosis, hospital type, clinical stage, targeted therapy, and involvement in treatment decision-making were the main influencing factors of self-reported efficacy of treatment. Discussion Conclusively, CRC patients are not highly dominant in treatment decision-making and more likely to make treatment decisions with their family and doctors. Timely and effective communication between doctors and patients can bolster patient involvement in treatment decision-making.
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Affiliation(s)
- Xiao-Fen Gu
- Department of Student Affairs, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China
| | - Hui-Fang Xu
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Yin Liu
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Li Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yan-Qin Yu
- The Clinical Epidemiology of Research Center, Department of Public Health and Preventive Medicine, Baotou Medical College, Baotou, China
| | - Xi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiao-Hui Wang
- Department of Public Health, Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Wen-Jun Wang
- School of Nursing, Jining Medical University, Jining, China
| | - Ling-Bin Du
- Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Shuang-Xia Duan
- Department of Preventive Health, Xinxiang Central Hospital, Xinxiang, China
| | - He-Lu Cao
- Department of Preventive Health, Xinxiang Central Hospital, Xinxiang, China
| | - Yu-Qian Zhao
- Center for Cancer Prevention Research, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yun-Yong Liu
- Liaoning Office for Cancer Control and Research, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Juan-Xiu Huang
- Department of Gastrodiges, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Ji Cao
- Department of Cancer Prevention and Control Office, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan-Ping Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Chang-Yan Feng
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Xue-Mei Lian
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Jing-Chang Du
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Remila Rezhake
- Department of Student Affairs, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Ma
- Public Health School, Dalian Medical University, Dalian, China
| | - You-Lin Qiao
- Department of Student Affairs, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Muacevic A, Adler JR, Kahlam J, Ahlawat S. Quality of YouTube Videos Related to Colorectal Cancer Screening. Cureus 2023; 15:e33684. [PMID: 36788914 PMCID: PMC9920494 DOI: 10.7759/cureus.33684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/14/2023] Open
Abstract
Introduction YouTube, an unregulated video-sharing website, is the second most visited website on the internet. As more patients turn to the internet for information about colon cancer screening, it is important to understand what they are consuming online. Our goal was to evaluate YouTube videos about colon cancer screening to better understand the information patients are accessing. Methods We searched YouTube on October 28, 2020, using the following search terms sorted by relevance and view count: colonoscopy, colon cancer screening, virtual colonoscopy, colonoscopy alternatives, and cologuard. Videos longer than 10 minutes, not in English, and duplicates were excluded. Three evaluators graded each video using the DISCERN criteria. Numerical data were averaged into a composite score. Two-sided t-tests and one-way ANOVA tests were used to compare mean ratings between groups. Results Fifty videos were analyzed, with a total of 23,148,938 views, averaging 462,979 views per video. The average overall rating was 3.16/5. There was no difference between search methods, search terms, or presence of a physician. The average ratings for videos with gastroenterologists (3.08), other physicians (3.35), and non-physicians (3.09) were not significantly different. Videos without physicians had more views on average (1,148,677) compared to videos with gastroenterologists (157,846, p=0.013) or other physicians (35,730, p=0.013). Conclusion YouTube videos related to colon cancer screening were of good quality regardless of search terms, search methods, or presence of a physician. However, videos without physicians were viewed more frequently. Physicians should continue making videos that address deficits while increasing viewership.
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Bertels LS, van Asselt KM, van Weert HCPM, Dekker E, Knottnerus BJ. Reasons for No Colonoscopy After an Unfavorable Screening Result in Dutch Colorectal Cancer Screening: A Nationwide Questionnaire. Ann Fam Med 2022; 20:526-534. [PMID: 36443069 PMCID: PMC9705029 DOI: 10.1370/afm.2871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/09/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We aimed to assess participant-reported factors associated with non-follow-up with colonoscopy in colorectal cancer (CRC) screening. METHODS In May 2019, we distributed a nationwide cross-sectional questionnaire (n = 4,009) to participants in the Dutch CRC screening program who received a positive fecal immunochemical test (FIT). Among respondents who reported no colonoscopy, we assessed the presence of a contraindication, and those without were compared with those who reported colonoscopy by logistic regression analysis. RESULTS Of 2,225 respondents (56% response rate), 730 (33%) reported no colonoscopy. A contraindication was reported by 55% (n = 404). Decisional difficulties (odds ratio [OR] = 0.29; 95% CI, 0.18-0.47), lacking the opportunity to discuss the FIT outcome (OR = 0.45; 95% CI, 0.28-0.72), and a low estimated risk of CRC (OR = 0.45; 95% CI, 0.26-0.76) were negatively associated with follow-up. Knowledge items negatively associated with follow-up included having an alternative explanation for the positive FIT (OR = 0.3; 95% CI, 0.21-0.43), having trust in the ability to self-detect CRC (OR = 0.42; 95% CI, 0.27-0.65), and thinking that polyp removal is ineffective (OR = 0.59; 95% CI, 0.43-0.82). The belief that the family physician would support colonoscopy showed the strongest positive association with follow-up (OR = 2.84; 95% CI, 2.01-4.02) CONCLUSIONS: Because decisional difficulties and certain convictions regarding CRC and screening are associated with non-follow-up, personalized screening counseling might be an intervention worth exploring as a means of improving follow-up in the Dutch CRC screening program. Involving family physicians might also prove beneficial.
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Affiliation(s)
- Lucinda S Bertels
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Cancer Center Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands .,Erasmus School of Health Policy and Management, Socio-Medical Sciences, Rotterdam, The Netherlands
| | - Kristel M van Asselt
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Cancer Center Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Cancer Center Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Evelien Dekker
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Bart J Knottnerus
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Cancer Center Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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Cheng YW, Li YC. Examining the Factors That Affect the Diagnosis of Patients with Positive Fecal Occult Blood Test Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137569. [PMID: 35805251 PMCID: PMC9265584 DOI: 10.3390/ijerph19137569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022]
Abstract
Due to the threat of colorectal cancer (CRC) to health, Taiwan included the fecal occult blood test (FOBT) under preventive health services in 2010. We examined the factors that affect the diagnosis of people with positive FOBT results. Data were retrospectively collected from the CRC screening database. In the model predicting factors that affect the diagnosis of 89,046 people with positive FOBT results, the risks of disease in the CRC group were lower in medical institutions that conducted follow-up examinations in regions such as Northern Taiwan compared to that in Eastern Taiwan (p = 0.013); they were lower in the age group of 50 to 65 years than those in the age group of 71 to 75 years (p < 0.001, p = 0.016), and lower in the outpatient medical units that conducted follow-up examinations than those in the inpatient medical units by 0.565 times (p < 0.001, 95% CI: 0.493−0.647). Factors affecting the diagnosis of patients with positive FOBT results were gender, the region of the medical institution, medical unit for follow-up examinations, age, screening site, family history, type of follow-up examinations, and follow-up time. Therefore, the identification of characteristics of patients with positive FOBT results and the promotion of follow-up examination are important prevention strategies for CRC.
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Affiliation(s)
- Yin-Wen Cheng
- Department of Business Management, College of Management, National Sun Yat-Sen University, No. 70, Lien-Hai Rd., Gushan Dist., Kaohsiung 80424, Taiwan;
| | - Ying-Chun Li
- Institute of Health Care Management, National Sun Yat-Sen University, No. 70, Lien-Hai Rd., Gushan Dist., Kaohsiung 80424, Taiwan
- Correspondence: ; Tel.: +886-7-5252000 (ext. 4875)
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Abstract
Colorectal cancer (CRC) continues to be the third leading cause of cancer-related deaths in the US. Colonoscopy remains the best preventative tool against the development of CRC. As a result, high-quality colonoscopy is becoming increasingly important. Specifically, recent guidelines have highlighted pre-procedural, peri-procedural, and post-procedural practices, which promise to improve patient outcomes and reduce the mortality and interval cancer rates in patients undergoing colonoscopies. Despite the guidelines and advances in modern endoscopy, the procedure remains provider-dependent, which results in differences in outcomes. As a result, incorporating high-quality colonoscopy approaches early in training is key to improving patient outcomes. Additionally, ensuring that high-quality colonoscopy is practiced widely by endoscopists can lead to the most cost-effective care.
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Hong SN, Lee CK, Im JP, Choi CH, Byeon JS, Cho YS, Jung SA, Kim TI, Jeen YT. Efficacy and safety of split-dose bowel preparation with 1 L polyethylene glycol and ascorbate compared with 2 L polyethylene glycol and ascorbate in a Korean population: a phase IV, multicenter, randomized, endoscopist-blinded study. Gastrointest Endosc 2022; 95:500-511.e2. [PMID: 34653425 DOI: 10.1016/j.gie.2021.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The 1-L polyethylene glycol (PEG)-based bowel preparation agent NER1006 (Plenvu; Norgine, Harefield, UK) has shown high cleansing efficacy and tolerability in clinical trials in Europe and North America. However, no clinical trials have yet been reported in Asia. Therefore, the aim of this study was to evaluate the efficacy and safety of 1L PEG-based bowel preparation with Plenvu compared with 2L PEG plus ascorbate bowel preparation in a Korean population. METHODS In this multicenter, endoscopist-blinded, randomized study, patients at 9 hospitals in South Korea undergoing colonoscopy received either Plenvu or 2L PEG + ascorbate (2L PEG) with a split dose. The primary endpoint was overall bowel cleansing success (Boston Bowel Preparation Scale [BBPS] score ≥2 for all segments of the colon). Secondary endpoints were high-quality bowel cleansing success (overall, BBPS score = 9; segmental colon, BPPS score = 3), polyp detection rate (PDR), and adenoma detection rate (ADR). RESULTS Of 360 included patients, cleansing efficacy was analyzed in 346 (Plenvu, 174; 2L PEG, 172). The Plenvu group showed noninferior bowel cleansing success rates compared with 2L PEG (93.10% vs 91.86%; difference, 1.24%; 1-sided 97.5% lower confidence limit, -4.31%; Pnoninferiority < .0001; Psuperiority = .661). The Plenvu group had higher high-quality bowel cleansing success rates for overall and right-sided colon segments than the 2L PEG group (49.43% vs 37.79% [P = .029] and 60.92% vs 48.84% [P = .024], respectively). The PDR was greater with Plenvu than with 2L PEG (48.85% vs 37.79%, P = .038). However, ADR did not differ between the 2 groups (24.71% vs 20.35%, P = .331). Although treatment-emergent adverse events (TEAEs) were slightly higher in the Plenvu group than in the 2L PEG group (65.71% vs 52.91%, P = .015), most TEAEs were mild (85.55%) and most patients recovered without any management (99.23%). CONCLUSIONS Plenvu showed noninferior overall bowel cleansing success rates comparable with 2L PEG but greater high-quality bowel cleansing in overall and right-sided colon, which might help improve the PDR in the Asian population. (Clinical trial registration number: KCT0005894.).
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Affiliation(s)
- Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Kyun Lee
- Department of Gastroenterology and Hepatology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hwan Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Could a Behavioral Model Explain Adherence to Second-Level Colonoscopy for Colon Cancer Screening? Results of a Cross-Sectional Study of the Palermo Province Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052782. [PMID: 35270473 PMCID: PMC8910366 DOI: 10.3390/ijerph19052782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/04/2022]
Abstract
According to Italian Essential Levels of Assistance (ELA), a colonoscopy is strongly recommended after a positive fecal occult blood test (FOBT) due to its effectiveness in early colorectal cancer detection. Despite the evidence, the Palermo province population (Italy), after a positive FOBT, have a lower colonoscopy adherence compared to Italian standards. This cross-sectional study analyzed patients’ perceptions of colonoscopy procedures to understand the reasons for non-adherence. Patients with a positive FOBT who did not undergo a colonoscopy within the national organized screening program were administered a telephone interview based on the Health Belief Model (HBM) questionnaire. The number of non-compliant patients with a colonoscopy after a positive FOBT were 182, of which 45 (25.7%) patients had undergone a colonoscopy in another healthcare setting. Among the HBM items, in a multivariate analysis only perceived benefits were significantly associated with colonoscopy adherence (aOR = 6.7, p = 0.03). Health promotion interventions should focus on the importance of the benefits of colorectal screening adherence to prevent colorectal cancer, implementing health communication by healthcare workers that have closer contacts with people, as general practitioners.
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Manning J, Halonen J, Cheriyamkunnel SJ, Álvarez-González MA. 1L NER1006 can improve rates of adequate and high-quality bowel cleansing in the right colon: a post hoc analysis of two randomised clinical trials. BMC Gastroenterol 2022; 22:35. [PMID: 35078404 PMCID: PMC8787873 DOI: 10.1186/s12876-022-02106-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The right colon is difficult to cleanse compared with other colon segments. This post hoc analysis of two randomised clinical trials (MORA and NOCT) examined whether 1L polyethylene glycol (PEG) NER1006 and two mid-volume alternatives could improve adequate and high-quality cleansing in the right colon among patients with complete cleansing assessments. METHODS Patients received NER1006 (N2D), 2L PEG plus ascorbate (2LPEG) or oral sulphate solution (OSS) as a 2-day evening/morning split-dosing regimen or NER1006 as a same-day morning-only dosing regimen (N1D). Patients had full segmental scoring assigned by treatment-blinded central readers using the Harefield Cleansing Scale. The right colon adequate (score ≥ 2) and high-quality (score ≥ 3) cleansing success of NER1006 (N2D and N1D) versus 2LPEG and OSS was analysed individually and as pooled groups (N2D vs. 2LPEG/OSS). We assessed the comparative right colon cleansing rates of the N2D versus 2LPEG/OSS in overweight males. We also performed a multivariable regression analysis to examine factors affecting cleansing in the right colon. RESULTS A total of 1307 patients were included. Pooled N2D showed significantly improved rates of adequate-level cleansing in the right colon compared with 2LPEG (97.5% [504/517] vs. 94.6% [246/260]; p = 0.020) and OSS (97.5% [504/517] vs. 93.8% [244/260]; p = 0.006). In MORA, the rate of adequate right colon cleansing did not significantly differ between N1D and 2LPEG (95.2% [257/270] vs. 94.6% [246/260]; p = 0.383). The rate of right colon high-quality cleansing was significantly improved with N2D or N1D vs. 2LPEG (p < 0.001 for both), and was numerically higher with N2D versus OSS (p = 0.11). In overweight males, NER1006 delivered numerically higher adequate (p = 0.398) and superior high-quality (p = 0.024) cleansing rates versus 2LPEG/OSS. Multivariable regression analysis showed NER1006 was associated with adequate and high-quality cleansing (p = 0.031 and p < 0.001), while time between preparation and colonoscopy was negatively associated (p = 0.034 and p = 0.006). CONCLUSIONS NER1006 delivered improved rates of adequate and high-quality right colon cleansing compared with 2LPEG and OSS. The increased rate of high-quality cleansing with NER1006 versus its comparators was also seen in overweight males.
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Affiliation(s)
- Jonathan Manning
- Borders General Hospital, NHS Borders, Melrose, Berwickshire, UK
| | - Juha Halonen
- Norgine Ltd, Medical Affairs, Widewater Place Moorhall Road, Harefield, Uxbridge, UB9 6NS, UK.
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Ismail MS, Murphy G, Semenov S, McNamara D. Comparing Colon Capsule Endoscopy to colonoscopy; a symptomatic patient’s perspective. BMC Gastroenterol 2022; 22:31. [PMID: 35073873 PMCID: PMC8785487 DOI: 10.1186/s12876-021-02081-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 12/23/2021] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Colon Capsule Endoscopy (CCE) has proven efficacy in a variety of gastrointestinal diseases. Few studies have assessed patient-reported outcomes and preference between colonoscopy and CCE.
Methods
Patients from our centre who had both a CCE and colonoscopy within a 12-month period were identified. We performed over-the-phone interviews focused on satisfaction, comfort, and overall preference with a 10-point Likert scale. Electronic records were reviewed; reported Modified-Gloucester-Comfort-Scale (GCS) score, sedation, bowel preparation and endoscopist grade were documented. Data was compared between procedures. A Fishers exact test was used to compare proportions and a Student t-test was used to compare means, a p < 0.05 was considered significant.
Results
In all, 40 patients were identified, 57.5% (23/40) were female and the mean age was 48 years (24–78). All patients were referred for investigation of lower gastrointestinal symptoms as part of an ongoing study [Endosc Int Open. 2021;09(06):E965–70]. There was a significance difference in mean comfort (9.2 vs 6.7, p < 0.0001, 95% CI − 3.51 to − 1.44) but not satisfaction (8.3 vs 7.7, p = 0.2, 95% CI − 1.48 to 0.33) between CCE and colonoscopy. Main cause of dissatisfaction with CCE was bowel preparation and for colonoscopy was discomfort. Age and gender were not found to be variables. The correlation between GCS and patient reported values was weak (R = − 0.28). Overall, 77.5% (31/40) of patients would prefer a CCE if they required further bowel investigation. Of these, 77.4% (24/31) preferred a CCE despite the potential need for follow-up colonoscopy.
Conclusions
CCE has a high satisfaction rating (8.3 vs 7.7) and has a higher patient reported comfort rating (9.2 vs 6.7) than colonoscopy. Studies have confirmed CCE and colonoscopy have equivalent diagnostic yields. The majority of patients in our cohort prefer CCE to colonoscopy. CCE should be considered as an alternative to colonoscopy in selected individuals.
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Cheng YW, Li YC. Factors affecting the follow-up time after a positive result in the fecal occult blood test. PLoS One 2021; 16:e0258130. [PMID: 34610043 PMCID: PMC8491872 DOI: 10.1371/journal.pone.0258130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
In 2010, Taiwan included the fecal occult blood test (FOBT) under preventive health insurance services. For patients whose test positive, receiving follow-ups is paramount. This study investigated factors affecting the follow-up time of these patients. This retrospective study used data from the colorectal cancer screening archives. The study period was from 2010 to 2013, and the subjects were 50-75-year-old persons who tested positive for FOBT. The t test, one-way ANOVA, and multiple regression were performed to address the differences in the mean tracking period between variables such as the population's demographic characteristics. The mean follow-up time for the 98,482 participants whose screening results were positive exhibited significant differences (p < 0.001) according to medical unit region and classification, age, screening location, family history, examination method, and diagnosis. The model predicting the mean follow-up time predicted a period of 10.079 days longer for those whose hospital was on an offshore island than that of those whose hospital was in the eastern regions. The follow-up time was 1.257 days shorter for people who were inpatients than those who were outpatients and was 8.902 days longer for people who underwent double contrast barium enema plus flexible sigmoidoscopy than those who underwent other examination methods. Patients with a family history of colorectal cancer and those whose examination results indicated cancer had a follow-up time of 2.562 and 2.476 days shorter than those who did not know their family history and those with other results, respectively. Factors affecting the follow-up time of people whose FOBT results were positive consisted of the location and classification of the follow-up institution, age, screening location, family history, examination method, and diagnosis. This provides valuable references for improving the cancer screening program.
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Affiliation(s)
- Yin-Wen Cheng
- Department of Business Management, College of Management, National Sun Yat-Sen University, Kaohsiung, Taiwan, R.O.C
| | - Ying-Chun Li
- Institute of Health Care Management, National Sun Yat-Sen University, Kaohsiung, Taiwan, R.O.C
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Abstract
Mortality from colorectal cancer is reduced through screening and early detection; moreover, removal of neoplastic lesions can reduce cancer incidence. While understanding of the risk factors, pathogenesis, and precursor lesions of colorectal cancer has advanced, the cause of the recent increase in cancer among young adults is largely unknown. Multiple invasive, semi- and non-invasive screening modalities have emerged over the past decade. The current emphasis on quality of colonoscopy has improved the effectiveness of screening and prevention, and the role of new technologies in detection of neoplasia, such as artificial intelligence, is rapidly emerging. The overall screening rates in the US, however, are suboptimal, and few interventions have been shown to increase screening uptake. This review provides an overview of colorectal cancer, the current status of screening efforts, and the tools available to reduce mortality from colorectal cancer.
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Affiliation(s)
- Priyanka Kanth
- Division of Gastroenterology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - John M Inadomi
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Yu Y, Wu J. Presence of Metabolic Syndrome and Thyroid Nodules in Subjects with Colorectal Polyps. Med Sci Monit 2021; 27:e927935. [PMID: 33518699 PMCID: PMC7863561 DOI: 10.12659/msm.927935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Thyroid nodules (TNs) and metabolic syndrome (MS) have been individually associated with colorectal polyps. However, the potential joint relationship between them in relation to colorectal polyps has not been fully evaluated. This study aimed to validate the association of TNs/MS and colorectal polyps/adenomas and to determine the risk of colonic polyps in patients with TNs/MS. Material/Methods A retrospective study was conducted on patients undergoing routine health checks in the First Affiliated Hospital of Wenzhou Medical University from July 2014 to August 2017. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for colorectal polyps/adenomas after adjusting for confounding factors. Then patients were divided into 4 groups according to whether they had TNs or MS. Relative excess risks of interaction, attributable proportion, and synergy index were used to determine the additive interaction of TNs and MS on colorectal polyps/adenomas. Results A total of 4514 eligible patients were included in this study. TNs and MS were confirmed to be independent risk factors for colorectal polyps/adenomas. Compared with the group of TNs(−)/MS(−), the odds ratios of TNs(+)/MS(+) in colorectal polyps (odds ratio [OR]: 3.031, 95% confidence interval [CI]: 2.262–4.062, P<0.05) or adenomas (OR: 2.894, 95% CI: 2.099–3.990, P<0.05) were significantly increased, and there was an interactive additive effect between TNs and MS. Conclusions TNs and MS have an associative and superimposing effect on the increased occurrence of colorectal adenomas. Colonoscopy screening should be advocated for patients with both of these diseases.
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Affiliation(s)
- Yue Yu
- Department of Clinical Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
| | - Jiansheng Wu
- Department of Clinical Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland)
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The Impact of Sedation on Adenoma Detection Rate and Cecal Intubation Rate in Colonoscopy. Gastroenterol Res Pract 2021; 2020:3089094. [PMID: 33381166 PMCID: PMC7758148 DOI: 10.1155/2020/3089094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/05/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To explore the effect of sedation on the quality of colonoscopy. Methods The data collected from the Digestive Endoscopy Center of Shanghai Tongji Hospital from March 2012 to June 2019 were retrospectively analyzed. The rate of sedation and quality metrics of colonoscopy such as adenoma detection rate (ADR) and cecal intubation rate (CIR) were calculated. The logistic regression model was used to explore the relationship between sedation and quality metrics of colonoscopy. The interaction effects between experience of endoscopists and sedation on quality of colonoscopy was also investigated in subgroups stratified by total number of colonoscopies during career using the logistic regression model. Results A total of 63,417 colonoscopies including 11,417 colonoscopies without sedation and 52,000 colonoscopies with sedation were enrolled in our study. The proportion of colonoscopy with sedation was 82.0%. The ADR and CIR were all significantly higher in cases with sedation compared with cases without sedation (ADR, 22.5% vs. 17.0%, p < 0.001; CIR, 94.7% vs. 91.2%, p < 0.001). Multivariate analysis showed that the sedation was an independent factor associated with adenoma detection (OR = 1.448, 95% CI: 1.372~1.529, p < 0.001) and cecal intubation (OR = 1.560, 95% CI: 1.446~1.683, p < 0.001). A total of 14 endoscopists with complete colonoscopy data in our database and corresponding 20,949 colonoscopies data were enrolled for further analysis. The logistic regression model yielded a similar result that sedation was an independent factor on adenoma detection and cecal intubation when the factor, experience of endoscopists, was also entered into the model as a confounder (adenoma detection, OR = 1.408, 95% CI: 1.333~1.487, p < 0.001; cecal intubation, OR = 1.601, 95% CI: 1.482-1.729, p < 0.001). Conclusion Colonoscopy with sedation has a positive effect on ADR and CIR in all endoscopists with different experience of colonoscopy, which makes the quality of colonoscopy better.
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