ColonCancerCheck & Regional Updates. Cheryl Shoemaker RN, BScN, CON(C) March 19, 2014
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1 ColonCancerCheck & Regional Updates Cheryl Shoemaker RN, BScN, CON(C) March 19, 2014
2 Colorectal Cancer Facts 3 rd most commonly diagnosed cancer 2nd leading cause of cancer death in men & 3 rd cancer death in women No early warning symptoms 90% curable when found and treated early Both men and women can get colorectal cancer
3 Lifetime probabilities of developing or dying from colorectal cancer Est New cases diagnosed in 2013 & 3350 will die Men Women Developing CRC Dying from CRC 1/13 1/15 1/29 1/31 Source: Canadian Cancer Statistics 2013
4 Waterloo Wellington Facts Estimated: 112,000 eligible people in our region aged are NOT getting screened. (CSQI) SCREENING RATES 32% of average risk individuals participate in FOBT 55.4% of residents are up to date on colorectal screening (Flex sig/colonoscopy/fobt)
5 Anatomy
6 Progression to Cancer Progression to invasive cancer takes 10 years on average
7 Assessing Risk Assess for CRC signs and symptoms Symptoms (High Risk of CRC) No symptoms; 1 or more 1 st degree relatives with CRC Increased risk of CRC Age no symptoms, no affected 1 st degree relatives (average risk for CRC) Refer to Colonoscopy FOBT Not appropriate Refer for Colonoscopy; Start at 50 years of age or 10 years before age of relatives diagnosis FOBT every 2 years Flexible Sigmoidoscopy every 5 years
8 Invitations, Reminders & Result Correspondence 2 Steps for Screening Age FOBT FOBT + = Colonoscopy Family History = Colonoscopy
9 FOBT vs. Colonoscopy If Colonoscopy as Primary Screen: 3/1000 (50-74) 333 scopes:1 cancer Risks with Colonoscopy: Prep Risks Perforation Risks 1: Death 1:15000 Economy impact (cost of prep) Work/sick days/fear/anxiety ColonCancerCheck 2010 Program Report p. 7 ColonCancerCheck Clinical Tool: Evidence Summary 2008
10 FOBT instructions
11 FOBT kit rejections at the lab
12 Patients with a + FOBT OR Family History Refer to: Regional Colonoscopy Network WHY?
13 RCN WHY CHOOSE US? Regional Colonoscopy Network Centralized Bookings 4 Regional Hospitals Short wait times 3 weeks +FOBT & Family History Symptomatic Cases Nurse Education Quality Colonoscopies with Local Endoscopists Genetics Screening Seamless flow of Patient to GI Nurse Navigator
14 Patients with NEGATIVE FOBT / Refused FOBT can be referred to: Nurse Performed Flexible Sigmoidoscopy Lower 1/3 of the large colon to splenic flexure SMGH & GRH 4 gastroenterologists and 1 general surgeon Physician availability for clinics Colonoscopy referrals post RNFS if indicated
15 Benefits of Flexible Sigmoidoscopy Added screening option for average risk individuals Reduction in CRC incidence and mortality Detection & biopsy of polyps No sedation Simple prep Quick referrals Low perforation rate Patients highly satisfied
16 Symptomatic Patients? Refer to: REGIONAL COLONOSCOPY NETWORK Patients diagnosed with Colorectal Cancer will be automatically referred to our GI Nurse Navigator/GI DAP for work up
17 ColonCancerCheck will save lives 1,500 lives saved by ,500 lives saved by % Participation Provided by: Erasmus University Medical Center + Cancer Care Ontario Source: MISCAN Model, Ontario Cancer Registry, Ontario Population Estimates
18 Public Awareness Campaigns Time to Screen Commercials Radio/News paper Make the Pledge Build a Butt: Build a What?!
19 How can we help your office? ColonCancerCheck Program Screening Activity Report (SAR) Initiatives & Partnerships (Ipads/FluFOBT)
20 Invitation Letters Reminder Letters Results Letters FOBT GREEN KITS Colonoscopy Flexible Sigmoidoscopy - Coming
21 Screening Activity Report
22 Initiatives & Partnerships Start the Conversation IPAD initiative FLU-FOBT Pilot Project 3 Practices in Wellington 293 Invitations GOAL OF 10% screened Education/materials supplied by WWRCP
23 FLU-FOBT Pilot Results From invitations gave out 82 FOBT kits (24% eligible received an FOBT) After 6 weeks 47 FOBT kits returned (16% completed and returned an FOBT kit) 2-4 hrs impact on clinical staff overall
24 1% Increase If every primary care provider in the region successfully encouraged just 3 more patients each, this would represent a 1% increase.
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