ColonCancerCheck & Regional Updates Cheryl Shoemaker RN, BScN, CON(C) March 19, 2014
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
Lifetime probabilities of developing or dying from colorectal cancer Est. 8700 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
Waterloo Wellington Facts Estimated: 112,000 eligible people in our region aged 50-74 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)
Anatomy
Progression to Cancer Progression to invasive cancer takes 10 years on average
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 50-74 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
Invitations, Reminders & Result Correspondence 2 Steps for Screening Age 50-74 FOBT FOBT + = Colonoscopy Family History = Colonoscopy
FOBT vs. Colonoscopy If Colonoscopy as Primary Screen: 3/1000 (50-74) 333 scopes:1 cancer Risks with Colonoscopy: Prep Risks Perforation Risks 1:1000-3000 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
FOBT instructions
FOBT kit rejections at the lab
Patients with a + FOBT OR Family History Refer to: Regional Colonoscopy Network www.cancercare4primarycare.com WHY?
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
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 www.cancercare4primarycare.com
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
Symptomatic Patients? Refer to: REGIONAL COLONOSCOPY NETWORK www.cancercare4primarycare.com Patients diagnosed with Colorectal Cancer will be automatically referred to our GI Nurse Navigator/GI DAP for work up
ColonCancerCheck will save lives 1,500 lives saved by 2020 5,500 lives saved by 2030 50% Participation Provided by: Erasmus University Medical Center + Cancer Care Ontario Source: MISCAN Model, Ontario Cancer Registry, Ontario Population Estimates
Public Awareness Campaigns Time to Screen Commercials Radio/News paper Make the Pledge Build a Butt: Build a What?!
How can we help your office? ColonCancerCheck Program Screening Activity Report (SAR) Initiatives & Partnerships (Ipads/FluFOBT)
Invitation Letters Reminder Letters Results Letters FOBT GREEN KITS Colonoscopy Flexible Sigmoidoscopy - Coming
Screening Activity Report
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
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
1% Increase If every primary care provider in the region successfully encouraged just 3 more patients each, this would represent a 1% increase.