Invitation to Screening Colonoscopy in the Population at Familial Risk for Colorectal Cancer

Colorectal Cancer Screening for Persons With a Positive Family History—Evaluation of the FARKOR Program for the Secondary Prevention of Colorectal Cancer in Persons Aged 25 to 50

BACKGROUND

Persons with a positive family history of colorectal cancer (CRC) are more likely than others to develop CRC and are also younger at the onset of the disease. Nonetheless, the German Federal Joint Committee (G-BA, Gemeinsamer Bundes - ausschuss) recommends screening all persons aged 50 and above regardless of their family history. FARKOR was a project supported by the Innovation Fund of the G-BA to study the feasibility, efficacy, and safety of a risk-adapted early detection program for CRC among persons aged 25 to 50 without any specific past medical history.

METHODS

Physicians in private practice in Bavaria documented their activities relating to FARKOR online. The FARKOR process comprised a declaration of consent, a simplified family history for CRC, an optional, more comprehensive family history, a counseling session for participatory decision-making on further measures, and various modalities of screening (an immunological fecal occult blood test [iFOBT], colonoscopy, or no screening). Related physician activities outside the FARKOR process were assessed by record linkage between study data and data of the patients' health insurance carriers.

RESULTS

The simplified family history was documented in 25 847 persons and positive for CRC in 5769 (22.3%). 3232 persons had a more comprehensive family history, among whom 2054 (63.6%) participated in screening measures. 1595 underwent colonoscopy; 278 persons who had already undergone colonoscopy in the preceding five years were excluded from the analysis. Colonoscopy revealed adenoma in 232 persons (17,6 %), advanced adenoma in 78 (5.9%) and carcinoma in 4 (0.3%). There were no serious complications.

CONCLUSION

The detection rates in this study corresponded to those of persons aged 55 to 59 in the current early detection program. Despite numerous problems in the performance of the study (inconsistencies in documentation, external performance of screening measures on program participants), the results support the feasibility of a risk-adapted early detection program in the young target population with a family history of CRC.

Mapping psychosocial interventions in familial colorectal cancer: a rapid systematic review

Background

Approximately 5% of colorectal cancer (CRC) cases are part of a well-defined inherited genetic syndrome and up to approximately 30% of these cases have a clinically defined familial basis. Psychosocial interventions in familial colorectal cancer address aspects mainly focused on affective, cognitive and behavioural outcomes. The present review aims to systematically map out the available psychosocial interventions for individuals with a family history of CRC and describe the current state of the research.

Methods

An extensive electronic search was conducted to investigate the literature published until June 2020. Inclusion criteria consisted of quantitative studies published in English that explored the impact of psychosocial interventions for familial CRC, clearly defined the psychosocial intervention offered and included participants with a family history of CRC.

Results

The analysis included 52 articles. Genetic counselling, educational interventions, psychological interventions and multimodal interventions were identified across the studies. In terms of diagnoses, Lynch Syndrome, Familial Adenomatous Polyposis, Familial Colorectal Cancer were the main conditions included in the studies. Affective, cognitive, behavioural aspects and quality of life emerged as the most frequently explored outcomes. The studies included individuals with both personal and familial history of CRC or family history alone.

Conclusions

Our rapid review provides an overview of the literature exploring the impact of psychosocial interventions for familial CRC. The psychosocial interventions identified had an overwhelmingly positive impact across all types of outcomes measured. Genetic counselling appeared to be most beneficial, and this is expected as it is purposively designed to address genetic conditions. Further quantitative analysis of primary empirical research is needed to determine the efficacy and effectiveness of psychosocial interventions as well as the mechanisms through which they exert their effect.

An investigation of efficient nursing interventions in early diagnosis of cancer: A systematic review and meta-analysis

Background and Aims:

Due to the contradictory results of previous research and the lack of a specific study to address the effective nursing interventions in the early diagnosis of cancer, the purpose of this study was to determine the effect of nursing interventions on early diagnosis of cancer.

Methods:

This systematic review and meta-analysis were conducted during the last 5 years from 2015 to September 30, 2020. The articles related to the nursing interventions to early diagnosis of cancer were achieved from PubMed, Cochrane Library, Embase, ISI, Scopus databases, and Google and Google Scholar search engines. Risk-ratio with a 95% confidence interval (CI) between the intervention and control groups was determined using the fixed-effect model, and the Mantel–Haenszel method and I2 showed the heterogeneity of studies. Stata V16 software was used for meta-analysis.

Results:

The effect of an intervention on early diagnosis of breast cancer was evaluated using mammography, clinical breast examination, and breast self-exam. A total of 300 individuals participated in the study. RR results in the intervention group showed the effectiveness of nursing interventions on breast cancer detected early in both the mammography and colonoscopy (RR, 1.18 95% CI 0.57, 1.79. P =0.00 and RR, 0.58, 95% CI 0.42, 0.75, P = 0.00, respectively).

Conclusion:

A variety of nursing interventions including education, consultation, patient guidance, and reminders can have a positive impact on the early detection of cancers.

Awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China: a cross-sectional study

OBJECTIVE

To assess the awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China.

DESIGN

A cross-sectional study was employed.

SETTING

This study was conducted in nine hospitals in Hunan province, China.

PARTICIPANTS

Individuals with a high-risk for colorectal cancer were interviewed using a pretested structured questionnaire.

PRIMARY AND SECONDARY OUTCOME MEASURES

Knowledge, attitude towards colorectal cancer screening, sociodemographic factors associated with screening knowledge and behaviour and barriers of colorectal cancer screening.

RESULTS

This study included 684 participants. The mean knowledge score was 11.86/24 (SD 4.84). But over 70% of them held a positive attitude towards screening. Only 13.3% had undergone colorectal cancer screening. Independent factors related to knowledge were education level of college or above, working as a white collar, higher income, having health insurance, having seen a doctor in the past year and with a high perceived risk (p<0.05). Factors independently associated with screening behaviour included personal history of colorectal disease, having seen a doctor in the past year, previous discussion of colorectal cancer screening, high perceived risk and better knowledge (p<0.05). Main reasons for not undergoing screening were no symptoms or discomfort (71.1%), never having thought of the disease or screening (67.4%) and no doctor advised me (29.8%).

CONCLUSION

In China, the majority of high-risk people had deficient knowledge and had never undergone colorectal cancer screening. But most of them held a positive attitude towards the benefits of colorectal cancer screening. This has promising implications to design targeted educational campaigns and establish screening programmes to improve colorectal cancer awareness and screening participation. Healthcare professionals should advise high-risk individuals to participate in screening and inform them about cancer risk.

What is the effectiveness of various invitation methods to a colonoscopy in the early detection and prevention of colorectal cancer? Protocol of a systematic review

BACKGROUND

Colorectal cancer, a prevalent malignancy worldwide, is associated with numerous modifiable and non-modifiable risk factors that play a role in the early detection and successful treatment of cancer. Despite improvements in the availability and quality of screening methods, especially colonoscopy, and the substantial survival benefits of the early detection of colorectal cancer, patient participation remains low due to clinical reasons and patient barriers. Studies around the world have used various methods of invitation in order to promote patient uptake of colonoscopies. The main objective of this systematic review is to analyze the association between certain invitation procedures, the participation in colonoscopies, and important patient outcomes in the early detection and prevention of colorectal cancer.

METHOD

We will systematically search in electronic databases including Medline via PubMed and Ovid, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and the Cochrane Library. All studies will be described in a table of study characteristics with a risk of bias assessment. In addition, two authors will independently rate the overall quality of evidence for the critical outcomes using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group approach. Discrepancies regarding the inclusion of studies, data extraction, or risk of bias assessment will be resolved independently by one other reviewer. Due to the heterogeneous design of the studies that will be evaluated in this review, synthesizing data from these studies in the form of a meta-analysis may not be possible. In this instance, we can conduct a descriptive synthesis of data from these studies.

DISCUSSION

The results that arise from this systematic review will reflect the influence that various invitation procedures to a colonoscopy have on patient participation in these screenings. Drawing conclusions about the efficiency of various invitation methods to a colonoscopy can provide valuable information to both clinicians and patients and may not only improve future invitation-based patient recruitment to colonoscopy screenings, but also shape guidelines regarding prevention of colorectal cancer.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019128645.

Klug S, Gensichen J. Increasing Influenza Vaccination Rates in People With Chronic Illness

BACKGROUND

The safety and efficacy of influenza vaccination for the chronically ill are clearly supported by the evidence, yet vaccination rates in this vulnerable popu- lation remain low. This leads to many avoidable hospitalizations and deaths in Germany every year. The goal of this systematic review is to identify measures in primary care medicine that can be used to increase influenza vaccination rates among the chronically ill.

METHODS

This review was carried out as recommended in the PRISMA statement. A systematic literature search was performed. Only randomized, controlled trials were included in the analysis. Details can be found in the study protocol (PROSPERO, CRD42018114163).

RESULTS

15 trials were included in the analysis. Training sessions for medical practice teams focusing on a particular disease raised the vaccination rates by as much as 22%. A financial incentive had the greatest effect (relative risk [RR]: 2.79; 95% confidence interval: [1.18; 6.62]). Reminders via text message yielded a maximum 3.8% absolute increase in vaccination rates. Complex interventions were not found to be of any greater benefit than simple ones.

CONCLUSION

A variety of approaches can be effective. Focusing training sessions for medical practice teams on certain diseases may be of greater benefit than vacci- nation-centered training sessions. Reminder systems for doctors should be more reliably implemented. Simple strategies are perhaps the most suitable ones in the heterogeneous population of chronically ill persons. The limitations of this system- atic review include the heterogeneity of the studies that we examined and the small number of studies in each category.