Patient compliance with surveillance colonoscopy: patient factors and the use of a graded recall system

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Excerpt

Colorectal cancer is the second and third most common malignancy in women and men, respectively, and the fourth leading cause of cancer death worldwide.1 The Australian Institute of Health and Welfare estimated that in Australia in 2016 colorectal cancer was both the second most common cancer and the second most common cause of cancer‐related deaths.2 Subsequent to diagnosis, about two‐thirds of patients undergo surgical resection with curative intent. At one end of the spectrum, when diagnosed at an advanced stage the estimated 5‐year survival rate of colorectal cancer is only about 6%.3 In contrast, the estimated 5‐year survival rate of a locally confined, early stage cancer is as high as 91.1%.4 Early diagnosis and management is clearly beneficial both to the patient and the public health system.
Surveillance of colorectal neoplasia is based on the premise of the adenoma–carcinoma sequence, in which the accumulation of well‐characterized genetic changes over time can lead to dysplasia and neoplasia.5 Surveillance seeks to detect precursor lesions during this interval. Studies have long shown that colonoscopy is a cost‐effective method of surveillance.6 It offers the advantage of assessing the entire colon with the possibility of simultaneous biopsy or polypectomy, allowing for detection and treatment of neoplastic precursor lesions and cancers at an early stage of evolution.7 The National Polyp Study showed that colonoscopy and polypectomy, through the treatment of precursor lesions, reduces the incidence of colorectal cancer.8
Compliance with repeat flexible sigmoidoscopy has been quoted as high as 86% in clinical studies.8 In the National Polyp Study from the 1990s in the USA, 80% of participants returned for one or more colonoscopies.9 A US veteran population study showed surveillance compliance at 68%,10 while another cross sectional study in the USA showed rates up to 85%.11 Outside of clinical trials adenoma surveillance compliance rates have been as low as 27%.12
As of 2017 the National Health and Medical Research Council (NHMRC) is reviewing colorectal cancer surveillance guidelines. To date, surveillance algorithms are based on primary pathology and individual risk stratification. The primary aim of our study was to assess patient compliance with recall for surveillance colonoscopy outside a clinical trial in an Australian metropolitan‐based colorectal practice. Secondary outcome of this study was to identify potential factors affecting compliance; including both patient factors and a graded recall system.
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