Maggie Vance

Flexible Sigmoidoscopy Screening for Colorectal Cancer: Uptake in a Population-based Pilot Programme:

Objective The aim of this study was is to examine uptake of population-based, flexible sigmoidoscopy (FS) screening delivered by nurses in a socioeconomically and ethnically diverse area of London, England. Methods All adults aged 58 and 59 years registered at 34 general practices in North London (n = 2260) were mailed an invitation to attend FS screening at the local hospital. Results In total, 45% (1024/2260) accepted the invitation and attended, 5% (114/2260) accepted the invitation but failed to attend, 5% (111/2260) accepted the invitation but were unable to attend within the time-frame of the pilot study, 7% (165/2260) declined the offer, 27% (602/2260) did not respond, and 11% (244/2260) were ineligible or did not receive the invitation. Among those eligible to be screened, the uptake rate was 51% (1024/2016). Uptake did not differ by gender, but people living in the most affluent quintile of areas had a substantially higher uptake rate (63%) than those living in the most deprived quintile (38%). Conclusion Uptake of FS screening delivered as a population-based programme was over 50% among the eligible population in a socioeconomically and ethnically diverse area of London. Disparities in uptake should be addressed to avoid exacerbating health inequalities.

Uptake of population-based flexible sigmoidoscopy screening for colorectal cancer: a nurse-led feasibility study

Objective: To assess uptake of once-only flexible sigmoidoscopy (FS) in a community sample to determine whether FS would be viable as a method of population-based screening for colorectal cancer. Methods: All adults aged 60–64 years registered at three General Practices in North West London, UK (510 men and women) were sent a letter of invitation to attend FS screening carried out by an experienced nurse, followed by a reminder if they did not make contact to confirm or decline the invitation. The primary outcome was attendance at the endoscopy unit for a FS test. Results: Of the 510 people invited to attend, 280 (55%) underwent FS. Among non-attenders, 91 (18%) were ineligible for screening or did not receive the invitation, 19 (4%) accepted the offer of screening but were unable to attend during the study period, 52 (10%) declined the offer, 41 (8%) did not respond to the invitation, and 27 (5%) accepted the offer of screening but did not attend. Attendance among those eligible to be screened, who had received the invitation, was 67%. People from more socioeconomically deprived neighbourhoods were less likely to attend (odds ratio [OR] = 0.90; confidence interval [CI] = 0.84–0.96; P = 0.003). Women were more likely to attend than men (OR = 1.44; CI = 1.01–2.05; P = 0.041). Conclusions: Attendance rates in this pilot for nurse-led, population-based FS screening were higher than those reported in other FS studies, and comparable with adherence to fecal occult blood testing (FOBT) in the UK FOBT pilot. Having a female nurse endoscopist may have been responsible for increasing female uptake rates but this warrants confirmation in a larger study.

Use of multidetector-row computed tomographic colonography before flexible sigmoidoscopy in the investigation of rectal bleeding

Rectal bleeding clinics where patients usually undergo some form of examination, usually flexible sigmoidoscopy, are now commonplace. However, flexible sigmoidoscopy examines only the left colon and some patients, especially older individuals, may have proximal pathology. Because of this, whole-colon evaluation has been advocated for all patients aged over 50 years1. However, total colonoscopy adds to cost and morbidity, whereas barium enema lacks comparable sensitivity2. Furthermore, polypectomy cannot immediately follow barium enema and patients who require polypectomy must undergo bowel preparation twice. Computed tomographic (CT) colonography is an alternative imaging modality that has adequate sensitivity for neoplasia3; it could immediately precede endoscopy, and is safe and acceptable to patients4. The aim of this study was to determine the feasibility of performing CT colonography before flexible sigmoidoscopy in patients with rectal bleeding.

Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK.

Objectives Flexible sigmoidoscopy (FS) screening for colorectal cancer will be introduced into the National Cancer Screening Programmes in England in 2013. Patient-reported outcome measures (PROMs) from trial participants indicate high acceptability and no adverse physical or psychological consequences, but this may not generalize to routine screening in the community. This study examined PROMs in a community-based FS screening programme. Methods Eligible adults aged 58–59 (n = 2016) registered at 34 London general practices were mailed a National Health Service-endorsed invitation to attend FS screening. Pain and side-effects were assessed in a ‘morning-after’ questionnaire, and satisfaction was assessed in a three-month follow-up questionnaire. Anxiety, self-rated health and colorectal symptoms were assessed at prescreening and follow-up. Results In total, 1020 people attended screening and were included in the current analyses, of whom 913 (90%) returned the morning-after questionnaire, and 674 (66%) the follow-up questionnaire. The prescreening questionnaire had been completed by 751 (74%) of those who attended. The majority (87%) of respondents reported no pain or mild pain, and the most frequent side-effect (wind) was only experienced more than mildly by 16%. Satisfaction was extremely high, with 98% glad they had the test; 97% would encourage a friend to have it. From prescreening to follow-up there were no changes in anxiety or self-rated health, and the number of colorectal symptoms declined. Satisfaction and changes in wellbeing were not moderated by gender, deprivation, ethnicity or screening outcome. Conclusions PROMs indicate high acceptability of FS screening in 58–59 year olds, with no adverse effects on colorectal symptoms, health status or psychological wellbeing.

EFFICACY OF AN ACCELERATED COLONOSCOPY TRAINING WEEK: AUDIT FROM ONE NATIONAL COLONOSCOPY TRAINING CENTER IN THE UK

Background:  Poor performance and inadequate training in colonoscopy in the UK has been reported. Several centers across the UK run intensive hands‐on training courses but their efficacy has not been established.