Despite progress in detection and treatment, colorectal cancer (CRC) remains a leading cause of cancer-related deaths in the US. To reduce mortality rates, clinicians advise routine colonoscopies—especially for patients with a prior history of CRC. “We previously reported that only 56% of patients diagnosed and treated for CRC complete a 1-year surveillance colonoscopy,” stated Dr. Natasha Kwendakwema, a hematology-oncology fellow and incoming faculty member at UW Medicine and Fred Hutchinson Cancer Center. However, “the reasons for suboptimal surveillance in this population are not well described.” Under the direction of Dr. Rachel Issaka, an associate professor in the Public Health Sciences and Clinical Research Divisions at Fred Hutchinson Cancer Center, Dr. Kwendakwema and collaborators identified barriers that limit patients from returning for a 1-year surveillance colonoscopy following CRC removal and treatment. Their goal was to better understand these barriers and use these insights to recommend interventions to improve surveillance care among CRC survivors. The researchers held interviews with clinicians who care for CRC patients and published their findings in Cancer Medicine. Overall, they found that recommendations like follow-up surveillance colonoscopies are not always communicated effectively to the patient due to the patient having multiple healthcare teams overseeing their care.
A history of prior CRC increases a patient’s risk of developing CRC again. For this reason, physicians advise a 1-year surveillance colonoscopy following successful CRC treatment to catch CRC recurrence early. Previously, the Issaka research group reported that factors including old age, living without a partner, and a higher CRC stage negatively impacted a patient’s likelihood to return to the clinic for their 1-year surveillance colonoscopy. While informative, these barriers are generally difficult to change, at least on the side of the healthcare provider. To uncover additional barriers with greater modifiable potential, the researchers “interviewed clinicians who care for this population to identify reasons that might contribute to inadequate surveillance [and] to inform possible future interventions,” shared Dr. Kwendakwema. Interview responses were collected from 13 clinicians—four medical oncologists, four colorectal surgeons, two gastroenterologists, and three advanced practice providers. Ten of these clinicians spent most of their time on direct patient care. Dr. Kwendakwema summarized their findings from the interviews, “Clinicians identified fragmented care—like getting care across multiple healthcare systems—as a major barrier to surveillance colonoscopy completion because a lot of important follow-up reminders and notifications got lost between health systems. This speaks to the need for better care coordination across clinical practice sites for this population that is at increased risk of developing recurrent cancer.” Currently, about half of the CRC patients are returning for their 1-year surveillance colonoscopy. For those who are not, addressing these challenges in communication across healthcare systems may help to improve patient adherence, especially for those who have limited support at home.
Moving forward, “we will pair this information with findings from patient interviews to propose and pilot interventions aimed at addressing this issue,” commented Dr. Kwendakwema. One suggested intervention included using electronic reminders or navigators to contact patients about their 1-year surveillance colonoscopy. Despite having a small number of clinicians participating, the information gained from these interviews highlighted barriers that can be modified. Dr. Kwendakwema shared that this work was “conducted across the Cancer Consortium through the Value in Cancer Care (VCC) network which is an academic and community-integrated consortium of 217 medical oncologists from 14 health systems in Washington.”
The spotlighted research was funded by the National Institutes of Health. This work also received funding support from the Cancer Consortium P30 New Investigator award (CA015704).
Fred Hutch/University of Washington/Seattle Children's Cancer Consortium members Drs. Veena Shankaran and Rachel Issaka contributed to this work.
Kwendakwema CN, Hopkins T, Bell-Brown A, Simianu VV, Shankaran V, Issaka RB. 2024. Clinician perceptions on barriers and facilitators to 1-year surveillance colonoscopy completion in survivors of colorectal cancer. Cancer Med. 13(18):e70244.
Science spotlight writer Annabel Olson is a postdoctoral research fellow in the Nabet lab at Fred Hutchinson Cancer Center. Her research focuses on studying the mechanisms that drive cancer development for both genetic and virus-associated cancers. A key tool in her research is the use of targeted protein degradation to dissect dysregulated signaling pathways in cancer and to double as a relevant pre-clinical therapeutic platform.
For the Media