Screening for colorectal cancer: the role of the primary care physician

Triantafillidis, John K.; Vagianos, Constantine; Gikas, Aristofanis; Korontzi, M.; Papalois, Apostolos

doi:10.1097/meg.0000000000000759

Cited by 45 publications

(17 citation statements)

References 57 publications

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“…A more holistic view will help us to determine which individuals are at an increased risk of developing colorectal cancer or its precursor lesions, how these factors influence participating in population programmes, and which individuals may benefit most from colorectal cancer screening [ 31 ]. The role of GP has been changing with the introduction of organised programmes in which they do not directly order screening tests, but rather have an essential role in increasing participation and informing the target population [ 32 ]. The primary care setting offers a chance to address colorectal cancer screening issues with patients who attend for other reasons.…”

Section: Discussionmentioning

confidence: 99%

Impact of comorbid conditions on participation in an organised colorectal cancer screening programme: a cross-sectional study

et al. 2017

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BackgroundThere is controversy regarding how comorbidity impacts on colorectal cancer screening, especially in the context of organised programmes. The aim of this study is to assess the effect of comorbidities on participation in the Barcelona population-based colorectal cancer screening programme (BCCSP).MethodsCross-sectional study carried out in ten primary care centres involved in the BCCSP. Individuals aged 50 to 69, at average risk of colorectal cancer, who were invited to participate in the first round of the faecal immunochemical test-based BCCSP were included (2011–2012). The main variable was participation in the BCCSP. Comorbidity was assessed by clinical risk group status. Other adjusting variables were age, sex, socioeconomic deprivation, visits to primary care, smoking, alcohol consumption and body mass index. Logistic regression models were used to test the association between participation in the programme and potential explanatory variables. The results were given as incidence rate ratios (IRR) and their 95% confidence intervals (CI).ResultsOf the 36,208 individuals included, 17,404 (48%) participated in the BCCSP. Participation was statistically significantly higher in women, individuals aged 60 to 64, patients with intermediate socioeconomic deprivation, and patients with more medical visits. There was a higher rate of current smoking, high-risk alcohol intake, obesity and individuals in the highest comorbidity categories in the non-participation group. In the adjusted analysis, only individuals with multiple minor chronic diseases were more likely to participate in the BCCSP (IRR 1.14; 95% CI [1.06 to 1.22]; p < 0.001). In contrast, having three or more dominant chronic diseases was associated with lower participation in the screening programme (IRR 0.76; 95% CI [0.65 to 0.89]; p = 0.001).ConclusionsHaving three or more dominant chronic diseases, was associated with lower participation in a faecal immunochemical test-based colorectal cancer screening programme, whereas individuals with multiple minor chronic diseases were more likely to participate. Further research is needed to explore comorbidity as a cause of non-participation in colorectal cancer screening programmes and which individuals could benefit most from colorectal cancer screening.

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Section: Discussionmentioning

confidence: 99%

Impact of comorbid conditions on participation in an organised colorectal cancer screening programme: a cross-sectional study

et al. 2017

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“…Our findings support the role of GPs in the recruitment of asymptomatic individuals for CRC screening programs. Active interventions led by GPs for non-participants appears to be a feasible mechanism for increased participation rates[15,16]. Although personalized invitations in the Czech Republic can hypothetically coverall non-participants in the screening program, the gain as a result of this activity will have limits.…”

Section: Discussionmentioning

confidence: 99%

Viewpoints of the target population regarding barriers and facilitators of colorectal cancer screening in the Czech Republic

Kroupa

Ondrackova

Kovalčíková

et al. 2019

WJG

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BACKGROUND Public awareness of colorectal cancer (CRC) and uptake of CRC screening remain challenges. The viewpoints of the target population (asymptomatic individuals older than 50) regarding CRC screening information sources and the reasons for and against participation in CRC screening are not well known in the Czech Republic. This study aimed to acquire independent opinions from the target population independently on the health system. AIM To investigate the viewpoints of the target population regarding the source of information for and barriers and facilitators of CRC screening. METHODS A survey among relatives (aged 50 and older) of university students was conducted. Participants answered a questionnaire about sources of awareness regarding CRC screening, reasons for and against participation, and suggestions for improvements in CRC screening. The effect of certain variables on participation in CRC screening was analyzed. RESULTS Of 498 participants, 478 (96%) respondents had some information about CRC screening and 375 (75.3%) had participated in a CRC screening test. General practitioners (GPs) ( n = 319, 64.1%) and traditional media ( n = 166, 33.3%) were the most common information sources regarding CRC screening. A lack of interest or time and a fear of colonoscopy or positive results were reported as reasons for non-participation. Individuals aged > 60 years [adjusted odds ratio (aOR) = 2.30, 95% confidence interval (CI) (1.42-3.71), P = 0.001], females (aOR = 1.95, 95%CI (1.26-3.01) P = 0.003), and relatives of CRC patients (aOR = 4.17, 95%CI (1.82-9.58) P = 0.001) were more likely to participate in screening. Information regarding screening provided by physicians - GPs: (aOR = 8.11, 95%CI (4.90-13.41), P < 0.001) and other specialists (aOR = 4.19, 95%CI (1.87-9.38), P = 0.001) increased participation in screening. Respondents suggested that providing better explanations regarding screening procedures and equipment for stool capturing could improve CRC screening uptake. CONCLUSION GPs and other specialists play crucial roles in the successful uptake of CRC screening. Reduction of the fear of colonoscopy and simple equipment for stool sampling might assist in improving the uptake of CRC screening.

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“…A number of studies have reported and emphasized the importance of a PCP’s role in screening, early diagnosis, and management of several malignancies. 2,7,12,17,34 Moreover, PCPs play a major role in cancer survival, and their engagement with patients allows them to provide regular and improved follow-up care. 16 …”

Section: Discussionmentioning

confidence: 99%

Disparities in health care determine prognosis in newly diagnosed glioblastoma

Chandra¹,

Rick²,

Ore³

et al. 2018

Neurosurgical Focus

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OBJECTIVEGlioblastoma (GBM) is an aggressive brain malignancy with a short overall patient survival, yet there remains significant heterogeneity in outcomes. Although access to health care has previously been linked to impact on prognosis in several malignancies, this question remains incompletely answered in GBM.METHODSThis study was a retrospective analysis of 354 newly diagnosed patients with GBM who underwent first resection at the authors’ institution (2007–2015).RESULTSOf the 354 patients (median age 61 years, and 37.6% were females), 32 (9.0%) had no insurance, whereas 322 (91.0%) had insurance, of whom 131 (40.7%) had Medicare, 45 (14%) had Medicaid, and 146 (45.3%) had private insurance. On average, insured patients survived almost 2-fold longer (p < 0.0001) than those who were uninsured, whereas differences between specific insurance types did not influence survival. The adjusted hazard ratio (HR) for death was higher in uninsured patients (HR 2.27 [95% CI 1.49–3.33], p = 0.0003). Age, mean household income, tumor size at diagnosis, and extent of resection did not differ between insured and uninsured patients, but there was a disparity in primary care physician (PCP) status—none of the uninsured patients had PCPs, whereas 72% of insured patients had PCPs. Postoperative adjuvant treatment rates with temozolomide (TMZ) and radiation therapy (XRT) were significantly less in uninsured (TMZ in 56.3%, XRT in 56.3%) than in insured (TMZ in 75.2%, XRT in 79.2%; p = 0.02 and p = 0.003) patients. Insured patients receiving both agents had better prognosis than uninsured patients receiving the same treatment (9.1 vs 16.34 months; p = 0.025), suggesting that the survival effect in insured patients could only partly be explained by higher treatment rates. Moreover, having a PCP increased survival among the insured cohort (10.7 vs 16.1 months, HR 1.65 [95% CI 1.27–2.15]; p = 0.0001), which could be explained by significant differences in tumor diameter at initial diagnosis between patients with and without PCPs (4.3 vs 4.8 cm, p = 0.003), and a higher rate of clinical trial enrollment, suggesting a critical role of PCPs for a timelier diagnosis of GBM and proactive cancer care management.CONCLUSIONSAccess to health care is a strong determinant of prognosis in newly diagnosed patients with GBM. Any type of insurance coverage and having a PCP improved prognosis in this patient cohort. Higher rates of treatment with TMZ plus XRT, clinical trial enrollment, fewer comorbidities, and early diagnosis may explain survival disparities. Lack of health insurance or a PCP are major challenges within the health care system, which, if improved upon, could favorably impact the prognosis of patients with GBM.

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Screening for colorectal cancer: the role of the primary care physician

Cited by 45 publications

References 57 publications

Impact of comorbid conditions on participation in an organised colorectal cancer screening programme: a cross-sectional study

Impact of comorbid conditions on participation in an organised colorectal cancer screening programme: a cross-sectional study

Viewpoints of the target population regarding barriers and facilitators of colorectal cancer screening in the Czech Republic

Disparities in health care determine prognosis in newly diagnosed glioblastoma

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