Colon Cancer Screening Toolkit for Colorectal Cancer

No longer recruiting at 1 trial location

Overseen By Aimee James, Ph.D., MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Washington University School of Medicine

Disqualifiers: Age, Not clinic patient, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new toolkit to enhance follow-up care for individuals with positive colorectal cancer screenings. Many people miss the necessary colonoscopy after a positive test, reducing the effectiveness of early cancer detection. The study aims to improve care in rural areas such as Southern Illinois, where health services may be limited. Suitable candidates for this trial are individuals aged 45 to 75 who visit participating clinics or health events. As an unphased trial, this study provides a unique opportunity to improve healthcare access and outcomes in underserved communities.

Do I have to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this toolkit is safe for colorectal cancer screening?

Research shows that the Colorectal Cancer Toolkit is generally safe to use. This toolkit helps improve screening and follow-up for colorectal cancer. Screening is safe and recommended for adults starting at age 45. The toolkit aims to increase the number of people getting screened and ensure they receive follow-up care, which is important for preventing cancer.

No specific safety concerns have been reported for the toolkit itself. However, the screening process sometimes includes tests like colonoscopies, which can have rare risks such as bleeding or a small tear in the colon, with these risks increasing with age.

Overall, the toolkit is designed to help healthcare providers improve colorectal cancer screening and follow-up. It is based on best practices and evidence-based guidelines, making it a safe and effective tool for both patients and healthcare providers. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Colon Cancer Screening Toolkit because it could revolutionize how we approach colorectal cancer screening in primary care settings. Unlike standard screening methods, like colonoscopies and stool tests, this toolkit focuses on enhancing the knowledge and procedures within healthcare teams, aiming to streamline and improve the overall screening process. By evaluating and addressing elements like role clarity and workflow adaptations, this approach seeks to boost the effectiveness and satisfaction with colorectal cancer screening. This could lead to more efficient screenings and better patient outcomes, which is why researchers are keen to explore its potential impact.

What evidence suggests that the Colorectal Cancer Toolkit is effective for improving follow-up after positive FITs?

Research has shown that regular screening for colorectal cancer can prevent over one-third of deaths from this disease. The Colorectal Cancer Toolkit, used by participants in this trial, aims to increase the number of people getting screened and receiving follow-up care, which is crucial for early cancer detection. Screening not only helps find cancer but also removes growths that might turn cancerous before they become harmful. Studies have found that raising community awareness and using various screening methods can reduce cancer rates and deaths. This toolkit seeks to enhance these efforts, particularly in areas with limited healthcare resources. ^{1 2 3 6 7}

Who Is on the Research Team?

Aimee James, Ph.D., MPH

Principal Investigator

Washington University School of Medicine

Are You a Good Fit for This Trial?

This trial is for people in rural Southern Illinois who have had a positive fecal immunochemical test (FIT) for colorectal cancer and need to follow up with a colonoscopy. It's focused on primary care clinic sites affiliated with the Southern Illinois Healthcare Physician Hospital Organization.

Inclusion Criteria

You are affiliated with Southern Illinois Healthcare's Physician Hospital Organization (PHO).

The sites must be able to provide a broad range of primary care services, including both medical and dental care

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Implementation of multilevel colon cancer screening interventions in rural settings

44 months

Virtual site visits and interviews with providers and staff

Follow-up

Participants are monitored for colonoscopy completions after positive fecal immunochemical test

60 days

What Are the Treatments Tested in This Trial?

Interventions

• Colorectal Cancer Toolkit

Trial Overview The study is testing a 'Colorectal Cancer Toolkit' designed to improve follow-up rates after positive FIT results. The goal is to see if this toolkit helps more people get colonoscopies, which could lead to earlier detection of colorectal cancer in rural areas.

How Is the Trial Designed?

Group I: Primary Care Clinics Experimental Treatment 1 Intervention

* Southern Illinois Healthcare System will contact the site management and ask for participation in the study * Eligible providers and staff will be identified by clinic management. The research coordinator will work with the clinic to schedule a virtual site visit(s). The study team will interview providers and staff at the beginning and/or end of each active intervention period to assess knowledge and attitudes about CRC screening and follow-up processes, the Consolidated Framework for Implementation Research (CFIR) constructs such as role clarity within the clinical team, and satisfaction with the intervention and implementation. Post-implementation surveys will also ask about work-arounds and adaptations of the intervention tools and perceived efficacy.

Who Is Running the Clinical Trial?

Washington University School of Medicine

Lead Sponsor

Trials

2,027

Recruited

2,353,000+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Published Research Related to This Trial

In a study of 3121 asymptomatic veterans who underwent colonoscopy screening, adverse events occurred in only 2.8% of follow-up examinations, indicating that long-term colonoscopy screening is generally safe.

Serious cardiopulmonary events were the most common major complications, and a history of prior colonoscopic adverse events significantly increased the risk of future complications, suggesting the importance of assessing patients' medical histories before follow-up procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Longitudinal assessment of colonoscopy adverse events in the prospective Cooperative Studies Program no. 380 colorectal cancer screening and surveillance cohort. Kobe, EA., Sullivan, BA., Qin, X., et al.[2023]

In a study of 17,067 CT colonography examinations across 50 centers, only 0.08% of patients experienced potentially serious adverse events, indicating a very low incidence of complications associated with the procedure.

Among the adverse events, there were nine perforations, with a symptomatic perforation rate of just 0.03%, suggesting that while complications can occur, they are rare and often asymptomatic.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom. Burling, D., Halligan, S., Slater, A., et al.[2016]

An electronic primer message sent through a patient portal significantly increased colorectal cancer (CRC) screening completion rates from 32.1% to 37.6% in a study of 2339 average-risk patients aged 50 to 75 years.

Patients who opened the electronic primer message had a 7.3% higher screening completion rate, and the time to complete screening was also shorter in the intervention group, indicating that digital reminders can effectively enhance participation in CRC screening programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial. Goshgarian, G., Sorourdi, C., May, FP., et al.[2022]

Only 42.5% of U.S. adults aged 50 and older reported undergoing recommended colorectal cancer tests, highlighting a significant gap in screening despite its effectiveness in reducing cancer incidence and mortality.

Key barriers to screening included lack of awareness and not receiving a recommendation from a physician, indicating that improving education and access to healthcare could enhance screening rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patterns and predictors of colorectal cancer test use in the adult U.S. population. Seeff, LC., Nadel, MR., Klabunde, CN., et al.[2022]

The proportion of individuals aged 50 to 75 years who were up to date with colorectal cancer screening increased significantly from 50.4% in 2011 to 69.7% in 2019, indicating improved screening rates over time.

The introduction of the multitarget stool DNA (mt-sDNA) test led to a notable increase in its use from 1.9% in 2016 to 14.2% in 2019, while the use of high-sensitivity fecal occult blood tests (FOBT) decreased from 17.7% to 6.6% during the same period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Utilization of a Colorectal Cancer Screening Test Among Individuals With Average Risk. Fisher, DA., Princic, N., Miller-Wilson, LA., et al.[2022]

In a study analyzing 130,831 colonoscopies, the overall bleeding rate was found to be 0.65%, with a very low rate of bleeding requiring transfusion (0.04%) and perforation (0.06%), indicating that the NHS bowel cancer screening program is relatively safe.

The study identified that larger polyp size and cecal location significantly increase the risk of adverse events, with cecal polypectomy showing a 13.5-fold increased risk of bleeding requiring transfusion and a 12.2-fold increased risk of perforation compared to distal colon procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Risk factors for adverse events related to polypectomy in the English Bowel Cancer Screening Programme. Rutter, MD., Nickerson, C., Rees, CJ., et al.[2022]

In a study of 1092 patients who underwent colorectal surgery as part of a screening program, 19.2% experienced in-hospital complications, with 5.9% classified as severe, highlighting the risks associated with surgical interventions in colorectal cancer screening.

Factors such as male sex, age over 60, and rectal lesion location were significantly associated with higher rates of complications, indicating that these demographics should be carefully considered when evaluating candidates for surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Surgical complications in a population-based colorectal cancer screening program: Incidence and associated factors. Sánchez Gómez, CA., Tejido Sandoval, C., de Vicente Bielza, N., et al.[2022]

About 30% of fecal immunochemical tests (FITs) for colorectal cancer screening were ordered prematurely, meaning they were done before the recommended time after a previous negative test, which could lead to unnecessary stress and resource waste.

Men were more likely to return for early screening than women, and male physicians were more likely to order these premature tests, indicating a potential need for better adherence to screening guidelines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Premature Fecal Immunochemical Testing in British Columbia Canada: a Retrospective Review of Physician and Screening Participant Characteristics. Sanders, D., Bakos, B., Gentile, L., et al.[2023]

A controlled trial involving 443 participants tested a combined intervention of a patient decision aid and practice-level support to increase colorectal cancer (CRC) screening rates, showing a modest increase in screening from 32.2% in usual care to 39% in the intervention group.

The intervention was particularly more effective for participants with higher incomes, suggesting that socioeconomic factors may influence the success of CRC screening interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of a patient and practice-level colorectal cancer screening intervention in health plan members: the CHOICE trial. Pignone, M., Winquist, A., Schild, LA., et al.[2021]

Colorectal cancer (CRC) screening has significantly contributed to the decline in CRC-related mortality by enabling early detection, highlighting the importance of following established guidelines.

The NCCN Guidelines for CRC Screening provide healthcare providers with recommendations tailored to individual risk levels, and the review also discusses the potential of emerging biomarkers to enhance screening effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of NCCN Guidelines, Other Guidelines, and Biomarkers for Colorectal Cancer Screening. Williams, CD., Grady, WM., Zullig, LL.[2021]

A randomized controlled trial will assess the effectiveness of a print-based intervention aimed at improving adherence to colonoscopy surveillance for colorectal cancer (CRC) patients and screening for their first-degree relatives, involving participants diagnosed with CRC within the last 10 months.

The study aims to provide evidence on effective strategies to enhance guideline adherence for CRC surveillance and screening, potentially improving outcomes for patients and their families over a follow-up period of 36 months.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving adherence to surveillance and screening recommendations for people with colorectal cancer and their first degree relatives: a randomized controlled trial. Carey, M., Sanson-Fisher, R., Macrae, F., et al.[2021]

Colonoscopy screening, when performed effectively, significantly reduces the risk of colorectal cancer and related mortality, but variations in the screening process can lead to failures that increase health risks.

Quality improvement in colonoscopy screening is essential, as higher quality practices have been shown to prevent cancer incidence and deaths, necessitating comprehensive guidelines for operators and systems to enhance screening outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimizing the Quality of Colorectal Cancer Screening Worldwide. Kaminski, MF., Robertson, DJ., Senore, C., et al.[2020]

Colorectal cancer screening significantly reduces mortality in individuals aged 50 and older, yet screening rates remain low despite the availability of various recommended tests like colonoscopy and fecal occult blood tests.

Barriers to screening exist for both patients and physicians, highlighting the need for strategies to improve compliance and increase participation in colorectal cancer screening programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Colorectal cancer screening: clinical applications. Walsh, JM., Terdiman, JP.[2019]

A large-scale survey of 147,439 computed tomographic colonography (CTC) examinations found a very low risk of adverse events, with colorectal perforations occurring in only 0.014% of cases and no reported deaths.

The risk of colorectal perforation was significantly lower during screening procedures (0.003%) compared to preoperative staging (0.028%), and 81% of perforation cases did not require emergency surgery, indicating that CTC is a safe option for colorectal cancer screening.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events during CT colonography for screening, diagnosis and preoperative staging of colorectal cancer: a Japanese national survey. Nagata, K., Takabayashi, K., Yasuda, T., et al.[2022]

Screening for colorectal cancer (CRC) and its precursors, like adenomas, is crucial for reducing mortality rates, with improved screening programs contributing to a decline in CRC deaths in industrialized countries.

Various screening methods exist, including fecal tests and structural tests like colonoscopy, but the newer video-colon capsule requires more research before it can be widely adopted as a screening tool.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guidelines for colorectal cancer screening--a puzzle of tests and strategies. Van Gossum, A.[2016]

Citations

1. gastro.org gastro.org/clinical-guidance/guideline-toolkits/colorectal-cancer-toolkit/

Colorectal cancer toolkit With routine colorectal cancer screening, more than 1 out of every 3 colorectal cancer deaths can be avoided. Colorectal cancers found in people without ...

2. nccrt.org nccrt.org/resource/evaluation-toolkit/

Evaluation Toolkit: How to Evaluate Activities to Increase ... The toolkit will help you learn the seven basic steps to evaluation, whether you are working to increase community demand for colorectal cancer screening.

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12306618/

Screen to Save: Results from NCI's Colorectal Cancer ... Screening to detect cancer and excise premalignant lesions has been proven to reduce overall colorectal cancer incidence and mortality rates.

4. ahrq.gov ahrq.gov/sites/default/files/publications/files/crctoolkit.pdf

Toolkit for the System Approach to Tracking and Increasing ... We find that many physicians think colonoscopy is the only successful screening method for colorectal cancer. Some may be unaware that several methods of ...

5. soar.usa.edu soar.usa.edu/cgi/viewcontent.cgi?article=1209&context=scholprojects

Best Practice Toolkit for Increasing Colorectal Cancer ... Comparative effectiveness of two interventions to increase colorectal cancer screening for those at increased risk based on family history ...

6. gi.org gi.org/education/educating-you-your-colleagues/colorectal-cancer-awareness-education-resources/crc-community-education-toolkit/

Colorectal Cancer (CRC) Community Education Toolkit Colorectal Cancer is one of the most preventable types of cancer. Based on evidence-based recommendations from the updated 2021 ACG Clinical Guidelines on ...

7. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK570913/

Screening for Colorectal Cancer: An Evidence Update ... - NCBI ToolKit, ToolKitAll ... Nineteen studies found increasing rates of serious adverse events with increasing age, including perforation and bleeding.