April 11, 2019
Research group identifies the nuanced barriers that prevent patients from following up on a positive colorectal cancer screening test
Colorectal cancer (CRC) is often detectable and beatable, yet it still remains the second leading cause of cancer-related death in Canada. Ontario offers an at-home CRC screening test, however not all patients who have abnormal test results receive the necessary follow-up care due to a number of factors. This means that there are missed opportunities to treat – and cure – some of these cancers.
Dr. Jill Tinmouth at the Sunnybrook Research Institute has set out to improve follow-up after a positive CRC screening test. The first step, Tinmouth says, is to understand why patients may be reluctant to follow up in the first place.
“The screening test for colorectal cancer is an easy, safe, painless, at-home fecal occult blood test (FOBT) but without proper follow-up of abnormal tests, it is all for naught,” says Tinmouth. The FOBT checks a person’s stool for tiny drops of blood, which can be caused by CRC. Colonoscopy is the recommended next step for anyone who has an abnormal FOBT. “Looking at the administrative data, we saw that nearly one in three people with an abnormal FOBT don’t follow up with colonoscopy within six months. We are working to both understand and fix this gap.”
In this first study, Tinmouth and collaborators looked into Ontario’s administrative health data to try to improve the lack of follow-up. These initial findings suggested that physicians may not be adhering to screening guidelines and led to better articulation of CRC screening and follow-up protocols to primary care providers.
“We made some modifications to our screening program to encourage physicians to follow up on positive FOBT results in a timely manner, but we recognized that these strategies wouldn’t solve every problem,” says Tinmouth. “To fully understand the gaps and barriers to following up, we knew we had to speak directly to patients and those in this position.”
In their most recent study on the subject, published in the American Journal of Gastroenterology, Tinmouth teamed up with Dr. Diego Llovet from Cancer Care Ontario to interview patients who failed to follow-up on positive FOBT results and physicians who care for those patients. Many of the patients believed that their test results were a false positive and others experienced fear, anxiety or uneasiness about the next step in CRC screening – a colonoscopy. Often, patients were reluctant to have a colonoscopy and physicians were unable to persuade their patients to follow through.
Tinmouth is now working with health system decision-makers and Cancer Care Ontario to test and pilot four different interventions that could help improve proper follow-up, including patient navigation through the screening process and reminders sent to physicians of patients who test positive but fail to follow up. This research group is evaluating the feasibility of these interventions and how Ontario could implement them across the province.
“Better colon cancer screening and care starts with understanding the barriers and then effectively implementing this new knowledge,” says Tinmouth. “On these projects, researchers worked hand-in-hand with policy-makers – in so doing, we were able to integrate our expertise and collective wisdom to improve colorectal cancer screening for Ontarians today and in the future.”
June 5, 2017
The samples will be combined with data from OHS’s online questionnaire to help researchers in the fight against chronic disease.
With the help of dedicated Ontarians across the province, The Ontario Health Study (OHS) has finished its blood collection phase, bringing the total number of samples donated by participants to over 41,000. This happened just in time to help the Canadian Partnership for Tomorrow Project, of which the OHS is part, reach the 150,000-sample mark for Canada’s 150th birthday.
Now the OHS is focusing on updating and augmenting its data from 230,000 Ontario participants who have completed the OHS online questionnaire to date (participants who provide a blood sample also had to complete the questionnaire). The OHS will be sending out follow-up questionnaires that will gather additional important details on the health and lifestyle of participants. The combination of data gathered from the blood sample collection program and the questionnaires will be used to generate information to help researchers fight chronic diseases such as cancer.
“In early February we let Study participants know that we were nearing the end of our blood collection program and the response from participants looking to donate before it ended was outstanding,” says Ms. Kelly McDonald, Program Manager of the OHS. “I think the fact that people were motivated by this deadline shows how interested the public is in helping health research and being part of something positive.”
The follow up questionnaires will help to make the information collected so far even more relevant for researchers by adding new fields and tracking developments in participant’s health and behaviour. “There are areas where we could use more information,” says McDonald. “We can now address ‘blind spots’ such as the use of over-the-counter medications, marijuana and e-cigarettes.”
The OHS database would be a powerful resource on its own, but the Study has taken steps to make it even more useful for scientists. They are working on cleaning up the data to eliminate inconsistencies and are linking OHS data with those at the Institute for Clinical and Evaluative Sciences and Cancer Care Ontario, which hold OHIP claims records and the Ontario Cancer Registry.
The OHS is currently working to increase awareness amongst researchers about the availability of its samples and data, and some researchers are already taking advantage of its potential. A group of Toronto-based researchers have used OHS data in a study looking at the mental health status of ethnocultural minorities in Ontario and their mental health care. In addition, another study called the Canadian Alliance for Healthy Hearts and Minds included OHS participants as a partner cohort.
OHS data will also be supporting research in several of OICR’s new Translational Research Initiatives, which were announced on May 25, 2017.
More information about the Study and further updates can be found at https://ontariohealthstudy.ca/