Post on 14-Aug-2020
Bowel Cancer Screening The Tallaght Experience
Nikki Shearer, RGN, BNS.
Overview
A multi-disciplinary approachOutline of Tallaght Hospital CRC screening programmeImproving public awarenessIdentifying target populationInviting interested individuals for participationProcessing of faecal samplesCoordinating endoscopic examinationsFollow up post colonoscopyEnd of year results 2010Coordinating research activitiesConclusions
Multi-disciplinary approach Screening for Colorectal Cancer
Compliance issues
Approach via health personnel Direct contact
Follow up of participants
•Leaflets: 36.95%
•Media: 9.65%
•Recommendation by GP 58.7%
Multi-disciplinary approach
Faivre J, Eur J Cancer Prev 91
Outline of Tallaght Hospital CRC Screening Programme
Contacting general practitioners in the Dublin 24 Obtaining details for individuals who fit criteriaBuilding relationship with the G.P. / Practice Nurse
The G.P. / Practice Nurse vital to promotion of the programme which helps make it a success
Improving Public Awareness
Organised introductory workshop for area general practitionersPrint mediaOrganised radio shows on CRC screeningColon cancer awareness day at local shopping centre
Identifying Target Population
Inviting suitable individuals for participation-Male, female-50-74 years of age-Dublin 24 Proper instructions to individuals with other co-morbid conditions
Process of invitation
Initial invite letter sent to individuals from G.P’s listFaecal Immunochemical Test (FIT) automatically sent out Accepting or declining the Programme does not impact their relationship with doctor / hospital Barriers: wrong addresses and deceased persons
Reminder letters
If no response to the kit, reminder letter posted outReminder letters have increased our response rateInitially, phone calls were made to encourage uptake, however this proved time consuming and many telephone numbers were incorrect.
Faecal Immunochemical Test
Kits sent by post Information and instructions given with each kit 2 FIT’s are required, samples taken on two consecutive days Samples secured in a small hard plastic tube Samples posted back via free post envelope Samples remain stable at room temperature for 7 days
Faecal Immunochemical Test (contd…)
Faecal Immunochemical Test (contd…)
Samples stored in a fridge at 4 degreesAnalysed in the lab once to twice a week Samples automated through O.C Sensor which gives print out of results The cut off reading for the programme is currently 100ng/ml
Faecal Immunochemical Test (contd…)
FIT Results
Results entered into a database manuallyWith a negative FIT result (under 100ng/ml) a letter will be posted out informing themRepeat the FIT in 2 yearsIf an individual has a positive result, they will be telephoned directly by the Nurse Coordinator
FIT Results (contd…)
A history is taken, if suitable, it will be explained that a colonoscopy is necessary A letter and info on having a colonoscopy will be sentG.P. will also be informed via letter
FIT Results (contd…)
Excluded if:-IBD-Had a colonoscopy in last 5 years-past history of Bowel Cancer
Once counselled by the Nurse-on a waiting list for a colonoscopyWith an available date they will be telephoned for pre-assessment and education given on preparation for the colonoscopy
ColonoscopyColonoscopies carried out on designated Saturdays in AMNCHOut of hours service, using existing facilitiesNot competing with an over burdened service2 consultant and full team2 endoscopy rooms with 2 recovery rooms 20-24 patients colonoscopies per day
Post Colonoscopy
Patients speak to consultant and nurse coordinator prior to dischargePatients are phoned 1-2 weeks post colonoscopy No pathology - a letter is sent to their G.P discharging them back to their careMinor pathology - results examined and the patient is contacted
Post Colonoscopy
Patients may need to be re-scoped in 2-5 years booked through the Endoscopy UnitIf polyps or pathology of concern is identified, the patient is referred to a Gastroenterologist (OPD)After endoscopy, a letter sent to G.P’s regarding results Patients with significant pathology discussed at the MDM
END OF YEAR RESULTS 2010
Participation
9,993 individuals, 99% of target populationOverall participation rate for round one 51%Significant increase in participation rates in year two 63% V 42%Women = 58%
25402523
5063
02000400060008000
10000120001400016000
Year 1 Year 2 Total
Invitees Participants
END OF YEAR RESULTS 2010
FIT Results and Positivity Rates
In all 10% (514) of returned FIT kits in round one were positiveYear one and year two of screening 11% and 9%
END OF YEAR RESULTS 2010
FIT Results and Positivity Rates
Older age group 9% (n=456) of programme participants & 16% of the FIT test positive population
48 43 9 37 46 170
10
20
30
40
50
% of Population Positivity Rate
50 - 59 60 - 69 70 - 74
END OF YEAR RESULTS 2010
Uptake of Colonoscopy
Overall Uptake 87% (419)Caecal Intubation 98% (409)
278
236
514
257
224
481
249
170
419
241
168
409
0 200 400 600
Year 1
Year 2
Total
Completed Colonoscopy
Underwent a Colonoscopy
Offered a Colonoscopy
Positive FIT
END OF YEAR RESULTS 2010Adenoma & Cancer Detection
Adenomatous polyps were detected in 154 (37%) subjectsCancer was found in 38 (9%)Mean age of patients with cancer was 61 yearsCancers were early, stage 1 in 31 (79%)
Number Percentage
All Polyp 206 49%
Hyperplastic polyps 52 12%
Tubular Adenomas 69 16%
Tubulovillous Adenoma 64 15%
High Grade Dysplasia 21 5%
Cancer 17 4%
END OF YEAR RESULTS 2010The Challenges
Increase demand for colonoscopy ~20%
Increased demand for Radiology and Pathology services
Need to target participation in certain sub-groups
NCSS- National Bowel Cancer Screening Programme
Coordinating research activities
Research being carried out in AMNCH with other multinational research centres screening for Colorectal CancerAim to identify new biomarkers for Colorectal CancerConsent obtained from patient prior to their colonoscopyIt requires:-bloods (plasma, serum, DNA,RNA)-stool sample (protein biomarker and DNA)-tissue sample (from adenoma greater than 1cm or lesion)
Conclusions
A patient centred service
Programme currently uses existing services and facilities
Patient satisfaction achieved:-pre-cancerous polypectomy -good nurse-patient relationship
Job satisfaction for staff as more pathology is found
To date no Surgery has refused to participate
Further positive attitude with successful programme
Public response rate increasing with more awareness
A National role-out of screening is likely to save more lives
Thank You