Colon cancer screening over half of patients never have it done

Main Category: Cancer / Oncology
Article Date: 21 Mar 2004 - 0:00 PDT

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Less than half of those for whom screening is recommended actually undergo the procedure. Physicians cite patient perceptions of preparation and procedure discomfort as barriers to greater screening compliance.

Patient education, including advice on bowel prep options, can alleviate anxieties and promote higher screening rates.

According to the Colon Cancer Alliance, more than 56,730 individuals die from colorectal cancer. There are four colorectal cancer screening tests available, the fecal occult blood test (FOBT), colonoscopy, flexible sigmoidoscopy, and double contrast barium enema (DCBE). Only the fecal occult blood test can be performed without a bowel prep.

Michael Brown, MD, says that only about 30% of Americans who are advised to undergo colon cancer screening actually go through with the procedure. Patients often believe the procedure is inconvenient and preparing for the screening unpleasant.

Compounding the matter is that patients often have questions about the procedure that are left unanswered by their physicians, making them more likely to avoid it.

According to Dr. Brown, patients are more likely to follow through with the screening when they have an open and working relationship with their physician.

"I make sure to routinely tell my patients that I have had a colonscopic cancer screening when discussing the procedure and that tends to put them more at ease. The personal touch can make a more significant difference than just handing a patient a pamphlet in the office or saying that a particular medical society recommends that a patient should undergo colonoscopic screening."

Every patient undergoing a colonoscopy needs a bowel preparation, regardless of whether it is a virtual colonoscopy or an endoscopic procedure.

"The bowel preparation must be effective and needs to thoroughly cleanse the colon because the lesions that we are looking for can be quite small," explains Dr. Brown. "Even some of the larger lesions can be occluded by impacted or solid fecal material."

"The biggest problem most patients have with colonoscopy is not the procedure itself," says Dr. Brown. "The current sedation techniques and versions of endoscopes make the procedure easy, quick, and for the most part painless. Patients dread the bowel preparation the most because they are asked to consume only clear liquids for an entire day. The bowel preparation for colon cancer screenings has historically called for patients to consume four liters of polyethylene glycol solution, but the taste of the solution is unpleasant and often leaves patients feeling nauseous and can induce vomiting."

Dr. Brown and colleagues recently completed a study that looked at patient preferences and found that about 80% of patients preferred to have a choice of bowel preps.

"There have been new developments in alternatives to the standard four-liter polyethylene glycol solution," says Dr. Brown. The FDA recently approved sodium phosphate tablets (Visicol, InKine Pharmaceuticals) as a bowel preparation alternative. Patients are instructed to take from 28 to 40 total tablets in split doses the night before and the day of the procedure.

"While patients still must consume only clear liquids, many patients prefer the tablets because they are tasteless and cause less nausea and vomiting," says Dr. Brown.

"The downside to taking the tablet form of the prep is that they can be difficult to swallow because they are fairly large pills. Despite that limitation, our recent study found that 90% of patients would repeat this type of prep if given the option as compared to only 12% who said they would repeat the standard four-liter polyethylene glycol solution."

Another bowel preparation recently approved is a phosphosoda- based prep (Fleet Pharmaceuticals), which is available in the AccuPrep kit. The prep is pre-measured in vials and has clear instructions for the patient to help limit potential errors.

"If a patient is unable to swallow pills, the phosphosoda-based prep is probably the next best option," says Dr. Brown. "While the solution does not taste good, it can be diluted with apple juice or clear sodas to improve the taste. Patients consume 1.5 ounces of phosphosoda the night before the procedure and another 1.5 ounces the day of the procedure, so the volume is still far less than the standard four-liter polyethylene glycol solution."

Dr. Brown's research investigations have shown the residual material tends to be clearer when using sodium phosphate or phosphosoda when compared to polyethylene glycol solutions. "The failure rate with sodium phosphate and phosphosoda is less than 3% while the rate for polyethylene glycol solutions can be as high as 8%," says Dr. Brown. "Patient satisfaction is also much higher with sodium phosphate or phosphosoda, so physicians should be aware that many patients are likely to request the new alternatives."

From Physician's Weekly:
http://www.physweekly.com/article.asp?issueid=117&articleid=1213