Time to Colonoscopy After Abnormal Stool-Based Screening and Risk for Colorectal Cancer Incidence and Mortality

Miguel, Yazmin San; Demb, Joshua; Martı́nez, Marı́a Elena; Gupta, Samir; May, Folasade P.

doi:10.1053/j.gastro.2021.01.219

Cited by 47 publications

(51 citation statements)

References 43 publications

(75 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CRC is also the second leading cause of cancer-related deaths [1] with a 5-year mortality rate of about 40% [2], which is also a great health burden in China [3,4]. Through the implementation of screening by serum carcinoembryonic antigen (CEA) and colonoscopy, increasing CRC patients could nowadays be diagnosed at an earlier stage before the formation of metastatic lesions [5,6], for whom surgical resection is the optimal treatment modality. However, a substantial proportion of patients still experience disease recurrence after the curative resection.…”

Section: Introductionmentioning

confidence: 99%

Postoperative circulating tumor DNA as markers of recurrence risk in stages II to III colorectal cancer

et al. 2021

View full text Add to dashboard Cite

Background Precise methods for postoperative risk stratification to guide the administration of adjuvant chemotherapy (ACT) in localized colorectal cancer (CRC) are still lacking. Here, we conducted a prospective, observational, and multicenter study to investigate the utility of circulating tumor DNA (ctDNA) in predicting the recurrence risk. Methods From September 2017 to March 2020, 276 patients with stage II/III CRC were prospectively recruited in this study and 240 evaluable patients were retained for analysis, of which 1290 serial plasma samples were collected. Somatic variants in both the primary tumor and plasma were detected via a targeted sequencing panel of 425 cancer-related genes. Patients were treated and followed up per standard of care. Results Preoperatively, ctDNA was detectable in 154 of 240 patients (64.2%). At day 3–7 postoperation, ctDNA positivity was associated with remarkably high recurrence risk (hazard ratio [HR], 10.98; 95%CI, 5.31–22.72; P < 0.001). ctDNA clearance and recurrence-free status was achieved in 5 out of 17 ctDNA-positive patients who were subjected to ACT. Likewise, at the first sampling point after ACT, ctDNA-positive patients were 12 times more likely to experience recurrence (HR, 12.76; 95%CI, 5.39–30.19; P < 0.001). During surveillance after definitive therapy, ctDNA positivity was also associated with extremely high recurrence risk (HR, 32.02; 95%CI, 10.79–95.08; P < 0.001). In all multivariate analyses, ctDNA positivity remained the most significant and independent predictor of recurrence-free survival after adjusting for known clinicopathological risk factors. Serial ctDNA analyses identified recurrence with an overall accuracy of 92.0% and could detect disease recurrence ahead of radiological imaging with a mean lead time of 5.01 months. Conclusions Postoperative serial ctDNA detection predicted high relapse risk and identified disease recurrence ahead of radiological imaging in patients with stage II/III CRC. ctDNA may be used to guide the decision-making in postsurgical management.

show abstract

Section: Introductionmentioning

confidence: 99%

Postoperative circulating tumor DNA as markers of recurrence risk in stages II to III colorectal cancer

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Others have similarly reported suboptimal follow-up of positive FIT, ranging from 18 to 57% in safety-net health systems [29][30][31]. This is especially concerning because delays in diagnostic colonoscopy increase risk of advanced adenoma, any CRC, and advanced-stage disease [32,33]. An ongoing challenge is that much of the literature is descriptive and focuses on patient characteristics associated with timely follow-up [34].…”

Section: Discussionmentioning

confidence: 99%

Colorectal Cancer Screening and Yield in a Mailed Outreach Program in a Safety-Net Healthcare System

et al. 2021

View full text Add to dashboard Cite

“…Due to patient preference and limited resources (6), FIT is a cornerstone for CRC screening in these settings. Among patients with an abnormal FIT result, a missed or delayed diagnostic colonoscopy increases CRC incidence and mortality (7)(8)(9)(10). Despite these concerns, the proportion of patients with an abnormal FIT result who complete a diagnostic colonoscopy rarely exceeds 50% in most safety-net systems and FQHCs (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Operationalizing a Rideshare Intervention for Colonoscopy Completion: Barriers, Facilitators, and Process Recommendations

et al. 2022

View full text Add to dashboard Cite

IntroductionTransportation is a common barrier to colonoscopy completion for colorectal cancer (CRC) screening. The study aims to identify the barriers, facilitators, and process recommendations to implement a rideshare non-emergency medical transportation (NEMT) intervention following colonoscopy completion within a safety-net healthcare setting.MethodsWe used informal stakeholder engagement, story boards—a novel user-centered design technique, listening sessions and the nominal group technique to identify the barriers, facilitators, and process to implementing a rideshare NEMT program following colonoscopy completion in a large safety-net healthcare system.ResultsBarriers to implementing a rideshare NEMT intervention for colonoscopy completion included: inability to expand an existing NEMT program beyond Medicaid patients and lack of patient chaperones with rideshare NEMT programs. Facilitators included: commercially available rideshare NEMT platforms that were lower cost and had shorter wait times than the alternative of taxis. Operationalizing and implementing a rideshare NEMT intervention in our healthcare system required the following steps: 1) identifying key stakeholders, 2) engaging stakeholder groups in discussion to identify barriers and solutions, 3) obtaining institutional sign-off, 4) developing a process for reviewing and selecting a rideshare NEMT program, 5) executing contracts, 6) developing a standard operating procedure and 7) training clinic staff to use the rideshare platform.DiscussionRideshare NEMT after procedural sedation is administered may improve colonoscopy completion rates and provide one solution to inadequate CRC screening. If successful, our rideshare model could be broadly applicable to other safety-net health systems, populations with high social needs, and settings where procedural sedation is administered.

show abstract

Time to Colonoscopy After Abnormal Stool-Based Screening and Risk for Colorectal Cancer Incidence and Mortality

Cited by 47 publications

References 43 publications

Postoperative circulating tumor DNA as markers of recurrence risk in stages II to III colorectal cancer

Postoperative circulating tumor DNA as markers of recurrence risk in stages II to III colorectal cancer

Colorectal Cancer Screening and Yield in a Mailed Outreach Program in a Safety-Net Healthcare System

Operationalizing a Rideshare Intervention for Colonoscopy Completion: Barriers, Facilitators, and Process Recommendations

Contact Info

Product

Resources

About