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Alimentary Pharmacology & Therapeutics Jun 2019Immune checkpoint inhibitors are used in the treatment of multiple advanced stage cancers but can induce immune-mediated colitis necessitating treatment with...
BACKGROUND
Immune checkpoint inhibitors are used in the treatment of multiple advanced stage cancers but can induce immune-mediated colitis necessitating treatment with immunosuppressive medications. Diagnostic colonoscopy is often performed but requires bowel preparation and may delay diagnosis and treatment. Sigmoidoscopy can be performed rapidly without oral bowel preparation or sedation.
AIMS
Characterize the colonic distribution of immune-mediated colitis to determine the most efficient endoscopic approach.
METHODS
A systematic review of checkpoint inhibitor-induced colitis case reports and series was conducted in both PubMed and Embase through 3 January 2017. A single centre retrospective chart review of patients who underwent endoscopic evaluation for diarrhoea after treatment with a checkpoint inhibitor (ipilimumab, nivolumab or pembrolizumab) between 1 January 2011 and 3 January 2017 was performed. Clinical, endoscopic and histologic data were collected.
RESULTS
A detailed systematic review resulted in 61 studies, in which 226 cases of colitis were diagnosed by lower endoscopy (125 colonoscopy, 101 sigmoidoscopy). Only four patients had isolated findings proximal to the left colon. In our centre, 31 patients had histologic features of checkpoint inhibitor-induced colitis, for which 29 patients had complete data. The left colon was involved in all cases. Sigmoidoscopy would be sufficient to diagnose >98% of reported cases of checkpoint inhibitor-mediated colitis diagnosed by lower endoscopy.
CONCLUSIONS
Moderate to severe checkpoint inhibitor-induced colitis involves the left colon in the majority of cases (>98%). Sigmoidoscopy should be the initial endoscopic procedure in the evaluation of this condition.
Topics: Antineoplastic Agents, Immunological; Colitis; Colon; Humans; Neoplasms; Retrospective Studies; Sigmoidoscopy
PubMed: 31035308
DOI: 10.1111/apt.15263 -
Journal of Primary Care & Community... Jan 2014To compare colorectal cancer screening rates in veterans receiving primary care (PC) in Veterans Administration (VA) community-based outpatient clinics (CBOCs) and VA...
OBJECTIVES
To compare colorectal cancer screening rates in veterans receiving primary care (PC) in Veterans Administration (VA) community-based outpatient clinics (CBOCs) and VA medical centers (VAMCs).
METHODS
The VA Outpatient Care Files were used to identify 2 837 770 patients ≥ 50 years with ≥ 2 PC visits in 2010. Veterans undergoing screening/surveillance colonoscopy, sigmoidoscopy, fecal-occult-blood testing (FOBT), and double-contrast barium enema (DCBE) were identified from ICD-9-CM/CPT codes. Patients were categorized as VAMC (n = 1 403 273; 49.5%) or CBOC (1 434 497; 50.5%) based on where majority of PC encounters occurred and as high risk (n = 284 090) or average risk (n = 2 553 680) based on colorectal cancer risk factors and validated ICD-9-CM-based algorithms.
RESULTS
CBOC patients were older than VAMC (mean ages 69.3 vs 67.4 years; P < .001), more likely (P < .001) to be male (96.5% vs 95.1%), and white (67.8% vs 64.2%), but less likely to be high-risk (9.4% vs 10.5%; P < .001). Rates of colonoscopy, sigmoidoscopy, and DCBE were all lower in CBOC (P < .001). Among high-risk veterans, rates in CBOC and VAMC, respectively, were 27.4% versus 36.8% for colonoscopy, 1.3% versus 0.8% for sigmoidoscopy, and 0.8% versus 0.5% for DCBE. Among average-risk veterans, these rates were 1.3% versus 1.9%, 0.2% versus 0.1%, and 0.2% versus 0.1%, respectively. The differences remained after adjusting for age/comorbidity. The adjusted odds of colonoscopy for CBOC were 0.73 (95% confidence interval = 0.64-0.82) for average risk and 0.76 (95% confidence interval = 0.67-0.87) for high risk. In contrast, the use of FOBT was relatively similar in CBOCs and VAMCs among both high risk (11.1% vs 11.2%) and average risk (14.3% vs 14.1%). Screening rates were similar between those younger than 65 years and older than 65 years.
CONCLUSIONS
Veterans receiving PC in CBOCs are less likely to receive screening colonoscopy, sigmoidoscopy, and DCBE than VAMC according to VA records. The lower use in CBOC was not offset by higher use of FOBT, including the degree to which CBOC patients may be more reliant to use non-VA services. The clinical appropriateness of these differences merits further examination.
Topics: Age Factors; Aged; Colorectal Neoplasms; Female; Health Behavior; Health Services Accessibility; Hospitals, Veterans; Humans; Male; Middle Aged; Multivariate Analysis; Occult Blood; Outpatient Clinics, Hospital; Patient Acceptance of Health Care; Primary Health Care; Risk Factors; Sex Factors; Sigmoidoscopy; Veterans
PubMed: 24327586
DOI: 10.1177/2150131913494842 -
BMJ (Clinical Research Ed.) Jul 1992
Review
Topics: Colorectal Neoplasms; Combined Modality Therapy; Forecasting; Humans; Palliative Care; Sigmoidoscopy
PubMed: 1382766
DOI: 10.1136/bmj.305.6847.246 -
The Western Journal of Medicine Nov 1995
Topics: Adult; Disinfectants; Female; Glutaral; Humans; Male; Middle Aged; Proctitis; Sigmoidoscopy
PubMed: 8533418
DOI: No ID Found -
Canadian Journal of Gastroenterology =... May 2007Colorectal cancer is a significant health burden. Several screening options exist that can detect colorectal cancer at an early stage, leading to a more favourable... (Review)
Review
Colorectal cancer is a significant health burden. Several screening options exist that can detect colorectal cancer at an early stage, leading to a more favourable prognosis. However, despite years of knowledge on best practice, screening rates are still very low in Canada, particularly in Ontario. The present paper reports on efforts to increase the flexible sigmoidoscopy screening capacity in Ontario by training nurses to perform this traditionally physician-performed procedure. Drawing on American, British and local experience, a professional regulatory framework was established, and training curriculum and assessment criteria were developed. Training was initiated at Princess Margaret Hospital and Sunnybrook and Women's College Health Sciences Centre in Toronto, Ontario. (During the study, Sunnybrook and Women's College Health Sciences Centre was deamalgamated into two separate hospitals: Women's College Hospital and Sunnybrook Health Sciences Centre.) Six registered nurses participated in didactic, simulator and practical training. These nurses performed a total of 77 procedures in patients, 23 of whom had polyps detected and biopsied. Eight patients were advised to undergo colonoscopy because they had one or more neoplastic polyps. To date, six of these eight patients have undergone colonoscopy, one patient has moved out of the province and another patient is awaiting the procedure. Classifying the six patients according to the most advanced polyp histology, one patient had a negative colonoscopy (no polyps found), one patient's polyps were hyperplastic, one had a tubular adenoma, two had advanced neoplasia (tubulovillous adenomas) and one had adenocarcinoma. All these lesions were excised completely at colonoscopy. Overall, many difficulties were anticipated and addressed in the development of the training program; ultimately, the project was affected most directly by challenges in encouraging family physicians to refer patients to the program. As health human resource strategies continue to evolve, it is believed that lessons learned from experience make an important contribution to the knowledge of how nontraditional health services can be organized and delivered.
Topics: Colorectal Neoplasms; Curriculum; Education, Nursing; Humans; Mass Screening; Nurse's Role; Ontario; Program Development; Program Evaluation; Referral and Consultation; Sigmoidoscopy
PubMed: 17505566
DOI: 10.1155/2007/719634 -
Cancer May 2017Screening for colorectal cancer (CRC) has been successful in decreasing the incidence and mortality from CRC. Although new screening tests have become available, their... (Comparative Study)
Comparative Study
BACKGROUND
Screening for colorectal cancer (CRC) has been successful in decreasing the incidence and mortality from CRC. Although new screening tests have become available, their relative impact on CRC outcomes remains unexplored. This study compares the outcomes of various screening strategies on CRC outcomes.
METHODS
A Markov model representing the natural history of CRC was built and validated against empiric data from screening trials as well as the Microstimulation Screening Analysis (MISCAN) model. Thirteen screening strategies based on colonoscopy, sigmoidoscopy, computed tomographic colonography, as well as fecal immunochemical, occult blood, and stool DNA testing were compared with no screening. A simulated sample of the US general population ages 50 to 75 years with an average risk of CRC was followed for up to 35 years or until death. Effectiveness was measured by discounted life years gained and the number of CRCs prevented. Discounted costs and cost-effectiveness ratios were calculated. A discount rate of 3% was used in calculations. The study took a societal perspective.
RESULTS
Colonoscopy emerged as the most effective screening strategy with the highest life years gained (0.022 life years) and CRCs prevented (n = 1068) and the lowest total costs ($2861). These values were 0.012 life years gained, 574 CRCs prevented, and a total cost of $3164, respectively, for FOBT; and 0.011 life years gained, 647 CRCs prevented, and a total cost of $4296, respectively, for DNA testing. Improved sensitivity or specificity of a screening test for CRC detection was not sufficient to close the outcomes gap compared with colonoscopy.
CONCLUSIONS
Improvement in CRC-detection performance is not sufficient to improve screening outcomes. Special attention must be directed to detecting precancerous adenomas. Cancer 2017;123:1516-1527. © 2017 American Cancer Society.
Topics: Adenocarcinoma; Adenoma; Aged; Colonography, Computed Tomographic; Colonoscopy; Colorectal Neoplasms; Computer Simulation; Cost-Benefit Analysis; DNA, Neoplasm; Early Detection of Cancer; Feces; Female; Health Care Costs; Hemoglobins; Humans; Male; Markov Chains; Middle Aged; Occult Blood; Sigmoidoscopy
PubMed: 28117881
DOI: 10.1002/cncr.30518 -
BMJ Case Reports Sep 2018
Topics: Colon, Sigmoid; Colonic Neoplasms; Diagnosis, Differential; Humans; Male; Narrow Band Imaging; Nerve Sheath Neoplasms; Sigmoidoscopy; Treatment Outcome; Young Adult
PubMed: 30262546
DOI: 10.1136/bcr-2018-227170 -
Public Health Reports (Washington, D.C.... 1989The reported practices and recommendations of primary care physicians with regard to cancer screening of elderly patients (65 years and older) were studied in a 1987...
The reported practices and recommendations of primary care physicians with regard to cancer screening of elderly patients (65 years and older) were studied in a 1987 survey of 400 Maryland physicians. More than 90 percent of physicians in four specialties studied reported providing digital rectal examinations, physical breast examinations, and mammography to the elderly. However, only 54 percent of obstetrician-gynecologists and 68 percent of general practitioners provided sigmoidoscopy, 70 percent of obstetrician-gynecologists provided stool guaiac slide tests, 74 percent of general practitioners provided breast self-exam instruction, and 79 percent of internists provided Pap tests. Physicians were asked what screening intervals they recommended for each test for asymptomatic elderly patients. These reports were compared with current American Cancer Society (ACS) recommendations. Large proportions of physicians in four specialties recommended sigmoidoscopy and mammography less often than the ACS recommended. More than 20 percent of physicians in the four specialties believed the elderly do not need routine sigmoidoscopy. Most physicians (90 percent or more) recommended Papanicolaou tests more often than the ACS recommended. Specialty and young physician age were the best predictors of physicians' overall adherence to ACS recommendations for cancer screening schedules.
Topics: Aged; American Cancer Society; Breast; Female; Health Services for the Aged; Humans; Mammography; Maryland; Mass Screening; Neoplasms; Occult Blood; Palpation; Papanicolaou Test; Physical Examination; Physicians, Family; Sigmoidoscopy; Vaginal Smears
PubMed: 2543020
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... May 2017
Comparative Study
Topics: Aged; Colorectal Neoplasms; Early Detection of Cancer; Endoscopy; Female; Humans; Indicators and Reagents; Male; Mass Screening; Middle Aged; Occult Blood; Pilot Projects; Sigmoidoscopy
PubMed: 28551972
DOI: 10.4045/tidsskr.16.1031 -
Cancer Dec 2017
Topics: Colorectal Neoplasms; Early Detection of Cancer; Humans; Mass Screening; Primary Prevention; Public Health; Sigmoidoscopy
PubMed: 28976554
DOI: 10.1002/cncr.31032