Supply and quality of colonoscopy according to the characteristics of gastroenterologists in the French population-based colorectalcancer screening program

BACKGROUND Since its complete roll-out in 2009,the French colorectal cancer screening program(CRCSP)experienced 3 major constraints[use of a less efficient Guaiac-test(gFOBT),stopping the supply of Fecal-Immunochemical-Test kits(FIT),and suspension of the program due to the coronavirus disease 2019(COVID-19)]affecting its effectiveness.AIM To describe the impact of the constraints in terms of changes in the quality of screeningcolonoscopy(Quali-Colo).METHODS This retrospective cohort study included screening-colonoscopies performed by gastroenterologists between Jan-2010 and Dec-2020 in people aged 50-74 living in Ile-de-France(France).The changes in Quali-colo(Proportion of colonoscopies performed beyond 7 mo(Colo_7 mo),Frequency of serious adverse events(SAE)and Colonoscopy detection rate)were described in a cohort of Gastroenterologists who performed at least one colonoscopy over each of the four periods defined according to the chronology of the constraints[gFOBT:Normal progress of the CRCSP using gFOBT(2010-2014);FIT:Normal progress of the CRCSP using FIT(2015-2018);STOP-FIT:Year(2019)during which the CRCSP experienced the cessation of the supply of test kits;COVID:Program suspension due to the COVID-19 health crisis(2020)].The link between each dependent variable(Colo_7 mo;SAE occurrence,neoplasm detection rate)and the predictive factors was analyzed in a two-level multivariate hierarchical model.RESULTS The 533 gastroenterologists(cohort)achieved 21509 screening colonoscopies over gFOBT period,38352 over FIT,7342 over STOP-FIT and 7995 over COVID period.The frequency of SAE did not change between periods(gFOBT:0.3%;FIT:0.3%;STOP-FIT:0.3%;and COVID:0.2%;P=0.10).The risk of Colo_7 mo doubled between FIT[adjusted odds ratio(aOR):1.2(1.1;1.2)]and STOPFIT[aOR:2.4(2.1;2.6)];then,decreased by 40%between STOP-FIT and COVID[aOR:2.0(1.8;2.2)].Regardless of the period,this Colo_7 mo’s risk was twice as high for screening colonoscopy performed in a public hospital[aOR:2.1(1.3;3.6)]compared to screening-colonoscopy performed in a private clinic.The neoplasm detection,which increased by 60%between gFOBT and FIT[aOR:1.6(1.5;1.7)],decreased by 40%between FIT and COVID[aOR:1.1(1.0;1.3)].CONCLUSION The constraints likely affected the time-to-colonoscopy as well as the colonoscopy detection rate without impacting the SAE’s occurrence,highlighting the need for a respectable reference time-tocolonoscopy in CRCSP.

Utilization of access to colorectal cancer screening modalities in low-income populations after medicaid expansion

BACKGROUND Colorectal cancer(CRC)remains a relevant public health problem.Current research suggests that racial,economic and geographic disparities impact access.Despite the expansion of Medicaid eligibility as a key component of the Affordable Care Act(ACA),there is a dearth of information on the utilization of newly gained access to CRC screening by low-income individuals.This study investigates the impact of the ACA’s Medicaid expansion on utilization of the various CRC screening modalities by low-income participants.Our working hypothesis is that Medicaid expansion will increase access and utilization of CRC screening by low-income participants.AIM To investigate the impact of the Affordable Care Act and in particular the effect of Medicaid expansion on access and utilization of CRC screening modalities by Medicaid state expansion status across the United States.METHODS This was a quasi-experimental study design using data from the Behavioral Risk Factor Surveillance System,a large health system survey for participants across the United States and with over 2.8 million responses.The period of the study was from 2011 to 2016 which was dichotomized as pre-ACA Medicaid expansion(2011-2013)and post-ACA Medicaid expansion(2014-2016).The change in utilization of access to CRC screening strategies between the expansion periods were analyzed as the dependent variables.Secondary analyses included stratification of the access by ethnicity/race,income,and education status.RESULTS A greater increase in utilization of access to CRC screening was observed in Medicaid expansion states than in nonexpansion states[+2.9%;95%confidence interval(95%CI):2.12,3.69].Low-income participants showed a+4.02%(95%CI:2.96,5.07)change between the expansion periods compared with higher income groups+3.19%(1.70,4.67).Non-Hispanic Whites and Hispanics[+3.01%(95%CI:2.16,3.85)vs+5.51%(95%CI:2.81,8.20)]showed a statistically significant increase in utilization of access but not in Non-Hispanic Blacks,or Multiracial.There was an increase in utilization across all educational levels.This was significant among those who reported having a high school graduate degree or more+4.26%(95%CI:3.16,5.35)compared to some high school or less+1.59%(95%CI:-1.37,4.55).CONCLUSION Medicaid expansion under the Affordable Care Act led to an overall increase in self-reported use of CRC screening tests by adults aged 50-64 years in the United States.This finding was consistent across all low-income populations,but not all races or levels of education.

Colorectal cancer:Getting the perspective and context right

Colorectal cancer(CRC)is a significant global health burden,being the third leading cancer globally.Its incidence has been observed to be higher in developed regions such as North America and Europe with geographical variations in mortality rates.Efforts to address this disease burden include promoting early detection through screening and implementing treatment strategies to improve patient outcomes.With the growing and aging population,the incidence of CRC will undoubtedly increase.These epidemiological trends will mean that healthcare professionals will increasingly encounter CRC in more complex patients.Hence,it becomes imperative to have a deeper appreciation of the pathophysiology of CRC and understand the intricate interplay between a patient’s physiology and their goals of care before offering treatment.This review article will aim to encapsulate the important nuances and perspectives of managing this disease in the context of an elderly patient.

Results of National Colorectal Cancer Screening Program in Croatia(2007-2011)

AIM:To study the epidemiologic indicators of uptake and characteristic colonoscopic findings in the Croatian National Colorectal Cancer Screening Program.METHODS:Colorectal cancer(CRC) was the second leading cause of cancer mortality in men(n = 1063,49.77/100 000),as well as women(n = 803,34.89/100 000) in Croatia in 2009.The Croatian National CRC Screening Program was established by the Ministry of Health and Social Welfare,and its implementation started in September,2007.The coordinators were recruited in each county institute of public health with an obligation to provide fecal occult blood testing(FOBT) to the participants,followed by colonoscopy in all positive cases.The FOBT was performed by hypersensitive guaiac-based Hemognost card test(Biognost,Zagreb).The test and short questionnaire were delivered to the home addresses of all citizens aged 50-74 years consecutively during a 3-year period.Each participant was required to complete the questionnaire and send it together with the stool specimen on three test cards back to the institute for further analysis.About 4% FOBT positive cases are expected in normal risk populations.A descriptive analysis was performed.RESULTS:A total of 1 056 694 individuals(born between 1933-1945 and 1952-1957) were invited to screening by the end of September 2011.In total,210 239(19.9%) persons returned the envelope with a completed questionnaire,and 181 102 of them returned it with a correctly placed stool specimen on FOBT cards.Until now,12 477(6.9%),FOBT-positive patients have been found,which is at the upper limit of the expected values in European Guidelines for Quality Assurance in CRC Screening and Diagnosis [European Union(EU) Guidelines].Colonoscopy was performed in 8541 cases(uptake 66%).Screening has identified CRC in 472 patients(5.5% of colonoscopied,3.8% of FOBT-positive,and 0.26% of all screened individuals).This is also in the expected range according to EU Guidelines.Polyps were found and removed in 3329(39% of colonoscopied) patients.The largest number of polyps were found in the left half of the colon:64%(19%,37% and 8% in the rectum,sigma,and descendens,respectively).The other 36% were detected in the proximal part(17% in the transverse colon and 19% in ceco-ascending colon).Small polyps in the rectum(5-10 mm in diameter),sigmoid and descending colon were histologically found to be tubular adenomas in 60% of cases,with a low degree of dysplasia,and 40% were classified as hyperplastic.Polyps of this size in the transverse or ceco-ascending colon in almost 20% had a histologically villous component,but still had a low degree of dysplasia.Polyps sized 10-20 mm in diameter were in 43% cases tubulovillous,and among them,32% had areas with a high degree of dysplasia,especially those polyps in the cecoascending or transverse part.The characteristics of the Croatian CRC Screening National Program in the first 3 years were as follows:relatively low percentage of returned FOBT,higher number of FOBT-positive persons but still in the range for population-based programs,and higher number of pathologic findings(polyps and cancers).CONCLUSION:These results suggest a need for intervention strategies that include organizational changes and educational activities to improve awareness of CRC screening usefulness and increase participation rates.

Continuous quality improvement of colorectal cancer screening

Quality assurance is a key issue in colorectal cancer screening, because effective screening is able to improve primary prevention of the cancer. The quality measure may be described in terms:how well the screening test tells who truly has a disease (sensitivity) and who truly does not have a disease (specificity). This paper raises concerns about identification of the optimal screening test for colorectal cancer. Colonoscopy vs flexible sigmoidoscopy in colorectal cancer screening has been a source of ongoing debate. A multicentre randomised controlled trial comparing flexible sigmoidoscopy with usual care showed that flexible sigmoidoscopy screening is able to diminish the incidence of distal and proximal colorectal cancer, and also mortality related to the distal colorectal cancer. However, colonoscopy provides a more complete examination and remains the more sensitive exam than flexible sigmoidoscopy. Moreover, colonoscopy with polypectomy significantly reduces colorectal cancer incidence and colorectal cancer-related mortality in the general population. The article considers the relative merits of both methods and stresses an ethical aspect of patient's involvement in decision-making. Patients should be informed not only about tests tolerability and risk of endoscopy complications, but also that different screening tests for bowel cancer have different strength to exclude colonic cancer and polyps. The authorities calculate effectiveness and costs of the screening tests, but patients may not be interested in statistics regarding flexible sigmoidoscopy screening and from an ethical point of view, they have the right to chose colonoscopy, which is able to exclude a cancer and precancerous lesions in the whole large bowel.

Colorectal cancer,screening and primary care: A mini literature review

Colorectal cancer(CRC) is a common health problem,representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality,with annual deaths estimated at 700000. The western way of life,that is being rapidly adopted in many regions of the world,is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore,the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians(PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein,we review the main topics of CRC in the current literature,in order to better understand its pathogenesis,risk and protective factors,as well as screening techniques. Furthermore,we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.

Colorectal cancer screening:20 years of development and recent progress

Colorectal cancer(CRC)is the second most common cancer in Europe and its incidence is steadily increasing.This trend could be reversed through timely secondary prevention(screening).In the last twenty years,CRC screening programs across Europe have experienced considerable improvements(fecal occult blood testing;transition from opportunistic to population based program settings).The Czech Republic is a typical example of a country with a long history of nationwide CRC screening programs in the face of very high CRC incidence and mortality rates.Each year,approximately 8000 people are diagnosed with CRC and some 4000 die from this malignancy.Twenty years ago,the first pilot studies on CRC screening led to the introduction of the opportunistic Czech National Colorectal Cancer Screening Program in 2000.Originally,this program was based on the guaiac fecal occult blood test(FOBT)offered by general practitioners,followed by colonoscopy in cases of FOBT positivity.The program has continuously evolved,namely with the implementation of immunochemical FOBTs and screening colonoscopy,as well as the involvement of gynecologists.Since the establishment of the Czech CRC Screening Registry in 2006,2405850 FOBTs have been performed and 104565 preventive colonoscopies recorded within the screening program.The overall program expanded to cover 25.0%of the target population by 2011.However,stagnation in the annual number of performed FOBTs lately has led to switching to the option of a population-based program with personal invitation,which is currently being prepared.

Colorectal cancer screening use among insured adults: Is out-of-pocket cost a barrier to routine screening?

AIM To describe the characteristics of adults who needed to see a doctor in the past year but could not due to the extra cost and assess the impact of limited financial resources on the receipt of routine fecal occult blood test, sigmoidoscopy, or colonoscopy for colon cancer screening among insured patients. METHODS Data obtained from the 2012 Behavioral Risk Factor Surveillance System included 215436 insured adults age 50-75 years. We computed frequencies, adjusted odds ratios(a ORs), and 95%CIs using SAS v9.3 software. RESULTS Nine percent of the study population needed to see a doctor in the past year but could not because of cost. The numbers were significantly higher among those aged 50-64(P < 0.0001), Non-Hispanic Whites(P < 0.0001), and those with a primary care physician(P < 0.0001) among other factors. Adjusting for possible confounders, a ORs for not seeing the doctor in the past year because of cost were: stool occult blood test within last year a OR = 0.88; 95%CI: 0.76-1.02, sigmoidoscopy within last year a OR = 0.72; 95%CI: 0.48-1.07, colonoscopy within the last year a OR = 0.91; 95%CI: 0.81-1.02. CONCLUSION We found that the limited financial resources within the past 12 mo were significantly associated with colorectal cancer(CRC) non-screening. Patients with risk factors identified in this study should adhere to CRC guidelines and should receive financial help if needed.

Psychological effects of colorectal cancer screening: Participants vs individuals not invited

AIM To investigate the possible long-term psychological harm of participating in colorectal cancer(CRC)screening in Norway.METHODS In a prospective, randomized trial, 14294 participants(aged 50-74 years) were invited to either flexible sigmoidoscopy(FS) screening, or a faecal immunochemical test(FIT)(1:1). In total, 4422 screening participants(32%) completed the questionnaire, which consisted of the Hospital Anxiety and Depression Scale and the SF-12, a generic health-related quality of life(HRQOL) measurement, when invited to screening and one year after the invitation. A control group of 7650 individuals was invited to complete the questionnaire only, at baseline and one year after, and 1911(25%) completed the questionnaires.RESULTS Receiving a positive or negative screening result and participating in the two different screening modalities did not cause clinically relevant mean changes in anxiety, depression or HRQOL after one year. FS screening, but not FIT, was associated with an increased probability of being an anxiety case(score ≥ 8) at the one-year follow-up(5.6% of FS participants transitioned from being not anxious to anxious, while 3.0% experienced the reverse). This increase was moderately significantly different from the changes in the control group(in which the corresponding numbers were 4.8% and 4.5%, respectively), P = 0.06. CONCLUSION Most individuals do not experience psychological effects of CRC screening participation after one year, while FS participation is associated with increased anxiety for a smaller group.

Adapting the PPRNet TRIP QI Model to Increase Colorectal Cancer Screening in Primary Care

Background: Established CRCS guidelines for providers and the public exist, but due to several versions of CRCS guidelines and the variety of test options, confusion often arises among patients and providers, adversely affecting CRCS rates. Improving providers’ opportunities to recommend CRCS through provider-directed office-system interventions is critical to increase CRCS rates. Objective: The purpose of this study was to demonstrate the feasibility of adapting provider-directed office-system interventions developed by the Practice Partner Research Network (PPRNet) Translation of Research into Practice (TRIP) Quality Improvement (QI) Model for implementation in an independent, rural West Virginia primary care practice, and to obtain estimates of variability for relevant outcome measures of the interventions to increase CRCS recommendation and rates. Methods: Retrospective and prospective patient data from medical records and electronic medical records were extracted to compare pre-with post-intervention CRCS rates and analyze any significant demographic data. Also, office staff participated in a focus group interview. Results: The pre-intervention CRCS status/completion rate was 4.3% and increased to 36.2%. CRCS recommendation rate rose from 4.3% to 42.1%. Patients in the post group were almost 7 times more likely to get CRCS recommendation compared to patients in the pre group, adjusting for demographic information. Similar to findings for CRCS recommendations, patients in the post group were more than 12 times more likely to have CRCS completion compared to their counterparts in the pre-group (OR 12.61, p < 0.000, CI: 8.30, 19.15). Conclusion: This study demonstrated the feasibility as well as statistically significant preliminary indications that CRCS rates will increase after implementation of this model.

Stool DNA methylation assays in colorectal cancer screening

Colorectal cancer(CRC) is fourth most common cancer in men and third in women worldwide. Developing a diagnostic panel of sensitive and specific biomarkers for the early detection of CRC is recognised as to be crucial for early initial diagnosis, which in turn leads to better long term survival. Most of the research on novel potential CRC biomarkers in the last 2 decades has been focussed on stool DNA analysis. In this paper, we describe the recent advances in non-invasive CRC screening and more specifically in molecular assays for aberrantly methylated BMP3 and NDRG4 promoter regions. In several research papers these markers showed superior rates for sensitivity and specificity in comparison to previously described assays. These tests detected the majority of adenomas ≥ 1 cm in size and the detection rates progressively increased with larger adenomas. The methylation status of the BMP3 and NDRG4 promoters demonstrated effective detection of neoplasms at all sites throughout the colon and was not affected by common clinical variables. Recently, a multitarget stool DNA test consisting of molecular assays for aberrantly methylated BMP3 and NDRG4 promoter regions, mutant KRAS and immunochemical assay for human haemoglobin has been made commercially available and is currently reimbursed in the United States. Although this is the most sensitive noninvasive CRC screening test, there is the need for further research in several areas- establishment of the best timeframe for repeated DNA stool testing; validation of the results in populations outside of North America; usefulness for surveillance and prognosis of patients; cost-effectiveness of DNA stool testing in real-life populations.

Colorectal cancer screening in Europe

Colorectal cancer(CRC)is the second most frequent malignant disease in Europe.Every year,412 000people are diagnosed with this condition,and 207 000patients die of it.In 2003,recommendations forscreening programs were issued by the Council of the European Union(EU),and these currently serve as thebasis for the preparation of European guidelines forCRC screening.The manner in which CRC screening iscarried out varies significantly from country to countrywithin the EU,both in terms of organization and thescreening test chosen.A screening program of onesort or another has been implemented in 19 of 27 EUcountries.The most frequently applied method is testing stool for occult bleeding(fecal occult blood test,FOBT).In recent years,a screening colonoscopy hasbeen introduced,either as the only method(Poland)orthe method of choice(Germany,Czech Republic).

Colorectal cancer screening in the COVID-19 era

Colorectal cancer(CRC)is the third most diagnosed form of cancer and second most deadly cancer worldwide.Introduction of better screening has improved both incidence and mortality.However,as the coronavirus disease 2019(COVID-19)pandemic began,healthcare resources were shunted away from cancer screening services resulting in a sharp decrease in CRC screening and a backlog of patients awaiting screening tests.This may have significant effects on CRC cancer mortality,as delayed screening may lead to advanced cancer at diagnosis.Strategies to overcome COVID-19 related disruption include utilizing stool-based cancer tests,developing screening protocols based on individual risk factors,expanding telehealth,and increasing open access colonoscopies.In this review,we will summarize the effects of COVID-19 on CRC screening,the potential longoutcomes,and ways to adapt CRC screening during this global pandemic.

A path for diagnosis and therapy of colon cancer: a continuous quality improvement

Objective： Prognosis of colorectal cancer strongly depends on stage at diagnosis, which can be cured in most cases at an early stage. The results were supported by different screening programmes. Few data concerning analysis of different phases of Colorectal Cancer Program were reported in literature. The aim of this study is to analyze ＂step by step＂, from a longitudinal type, the Colorectal Cancer Program, active at our Institution, verifying compliance with standards of care.Methods： We compared two different populations during the same period： patients referring to our Clinical Oncology Unit coming from Regional Colorectal Cancer Screening Program and the other population that was not in any Colorectal Cancer Program.Results： Considering patients from the Regional Colorectal Cancer Screening Program（19 patients, corresponding to 24.0% of the general case study）, 3（15.8%） were deceased and 16（84.2%） were alive without evidence of the disease（NED）. Concerning patients that are not coming from Regional Colorectal Cancer Screening Program（61 patients, corresponding to 76.0% of the general case study）, 9（14.8%） were deceased, 43（70.5%） were NED, 8（13.1%） were alive with metastases and 1（1.6%） was lost during follow-up（PFU）. Conclusions： On the basis of this experience, we concluded for high-quality care for both populations. Any critical point should be carefully analyzed in order to implement quality of care.

Confounders in Adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer

Background and Aims: The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there in increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. Methods: A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45 - 75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Results: Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance was associated with adenoma detection. Conclusion: In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.

Quality colonoscopy:A matter of time,technique or technology?

Quality colonoscopy is defined by the detection of adenomatous polyps at least 25% of the time in men and 15% of the time in women.Recent studies highlight the importance of key aspects of high quality colonoscopy.These include the amount of time spent examining the mucosa or withdrawal time,the quality of withdrawal technique and new technologies which seek to maximize the detection of colonic neoplasia.This review summarizes the latest evidence regarding the role of time,technique and technology in shaping the quality of colonoscopy.

Screening polypectomy rates below quality benchmarks:A prospective study

AIM:To estimate and compare sex-specific screening polypectomy rates to quality benchmarks of 40%in men and 30%in women.METHODS:A prospective cohort study was undertaken of patients aged 50-75,scheduled for colonoscopy,and covered by the Québec universal health insurance plan.Endoscopist and patient questionnaires were used to obtain screening and non-screening colonoscopy indications.Patient self-report was used to obtain history of gastrointestinal conditions/symptoms and prior colonoscopy.Sex-specific polypectomy rates(PRs)and95%CI were calculated using Bayesian hierarchical logistic regression.RESULTS:In total,45 endoscopists and 2134(mean age=61,50%female)of their patients participated.According to patients,screening PRs in males and females were 32.4%(95%CI:23.8-41.8)and19.4%(95%CI:13.1-25.4),respectively.According to endoscopists,screening PRs in males and females were 30.2%(95%CI:27.0-41.9)and 16.6%(95%CI:16.3-28.6),respectively.Sex-specific PRs did not meet quality benchmarks at all ages except for:males aged65-69(patient screening indication),and males aged70-74(endoscopist screening indication).For all patients aged 50-54,none of the CI included the quality benchmarks.CONCLUSION:Most sex-specific screening PRs in Québec were below quality benchmarks;PRs were especially low for all 50-54 year olds.

跟进式赋能教育在结直肠癌化疗患者中的应用效果

目的分析跟进式赋能教育对结直肠癌化疗患者健康信念、自护能力、生活质量的影响。方法选取2021年1月至2023年1月在安阳市肿瘤医院肿瘤内科收治的80例结直肠癌化疗患者进行随机对照试验。按照入院顺序的不同将所有研究对象分成对照组(40例)与试验组(40例)。对照组男性20例、女性20例,年龄34~79(56.74±8.96)岁,予以常规健康教育;肿瘤TNM分期:Ⅱ期26例,Ⅲ期14例。试验组男性21例、女性19例,年龄32~81(56.15±8.84)岁,以赋能教育理念为支持实施跟进式健康教育;肿瘤TNM分期:Ⅱ期25例,Ⅲ期15例。比较两组患者干预前后的中文版Champion结直肠癌健康信念量表(CHBMS)、修正版自我护理能力量表(ASAS-R-C)、McGill生活质量量表(MQOL-C)评分。统计学方法采用t检验。结果干预后,试验组中文版CHBMS评分与ASAS-R-C评分均高于对照组[(146.15±20.48)分比(126.65±22.47)分、(60.45±10.33)分比(52.36±8.77)分],差异均有统计学意义(t=4.06、3.78,均P<0.05)。干预后,试验组MQOL-C中生理、心理、个人存在感、社会支持评分均高于对照组[(24.15±3.06)分比(21.22±2.87)分、(41.26±3.74)分比(37.59±3.58)分、(42.22±3.69)分比(38.48±3.97)分、(24.36±3.18)分比(22.55±2.87)分],差异均有统计学意义(t=4.42、4.48、4.36、2.67,均P<0.05)。结论跟进式赋能教育可增强结直肠癌化疗患者健康信念,提高自护能力与生活质量。

Disability-adjusted life years and the trends of the burden of colorectal cancer:a population-based study in Shanghai,China during 2002 to 2016

Background:Colorectal cancer(CRC)still ranks the top in morbidity and mortality of cancers worldwide,posing a huge threat and burden to the society.We aimed to determine the age-standardized incidence,mortality,and disability-adjusted life years(DALYs)of CRC and explore potential changes in the temporal trends of the CRC burden in Shanghai during 2002 to 2016.Methods:The cancer statistics and demographics were obtained from the Cancer Registry and the Statistics Bureau of Pudong New Area,respectively.Data from 2002 to 2016 were included and analyzed retrospectively.DALYs were calculated using DisMod and the age-standardized rates(ASRs)were obtained according to Segi world standard population.Joinpoint regression was used to measure the trends in CRC incidence and to estimate the annual percent change.Results:The increasing trend of CRC ASR incidence halted after 2014,coinciding with the introduction of the Shanghai CRC screening program.The ASRs of mortality and DALYs increased,at 0.42%(P<0.05)and 4.07%(P<0.001)per year,respectively,which were mainly driven by men and individuals aged above the CRC screening program target.Conclusions:The disease burden of CRC in Shanghai remains serious,especially among men,and individuals aged>74 years.The benefits of the screening program have been partially proven by the ASRs of CRC incidence,providing important insights into better and wider application of screening programs.

基于ABC⁃X模型的结直肠癌术后造口病人康复护理干预方案的构建与应用

目的:基于ABC-X模型构建结直肠癌术后造口病人康复护理干预方案并探讨其应用效果。方法:通过参考国内外文献、专家函询、课题组讨论及预试验,基于ABC-X理论模型构建结直肠癌术后造口病人康复护理干预方案。经两轮德尔菲专家函询,最终构建了包括5个一级指标、18个二级指标和38个三级指标的基于ABC-X模型的结直肠癌术后造口病人康复护理干预方案。选取2022年2月—2023年2月于华北理工大学附属医院、唐山市工人医院、唐山市人民医院住院的结直肠癌术后96例造口病人,分为试验组48例和对照组48例,对照组实施常规护理,试验组在常规护理的基础上实施基于ABC-X模型的结直肠癌术后造口病人康复护理干预方案,比较两组病人结肠造口压力、肠造口自我管理能力及造口病人生活质量。结果:干预过程中,试验组脱落3例,对照组脱落2例,最终试验组45例,对照组46例。干预8周后,试验组身体状况改变所致压力、自我概念改变所致压力、结肠造口护理所致压力均较对照组降低(P<0.05),造口护理管理、信息管理、症状管理、日常生活管理及心理管理得分均较对照组提高(P<0.05),病人社会交往、造口袋对病人的影响、与家属和朋友的关系及身心状况改善均优于对照组(P<0.05)。结论:构建的基于ABC-X模型的结直肠癌术后造口病人康复护理干预方案科学可行,应用该方案能有效降低造口病人压力,提高病人肠造口自我管理能力及生活质量。