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.”
November 22, 2018
Dr. Lorraine Lipscombe investigates why the 20 per cent of cancer patients with diabetes often experience worse outcomes
Several studies show that health outcomes – such as overall survival and preventable hospitalizations – are worse for cancer patients who also have diabetes. However, the reasoning behind this disparity is unclear. Dr. Lorraine Lipscombe, an endocrinologist at Women’s College Hospital and Diabetes Canada Investigator Award holder, is investigating why these differences exist and what we can do to avoid preventable complications.
July 9, 2018
The BETTER program has been awarded almost $3 million to train primary care providers as prevention experts across Canada
As the number of Canadians at risk of cancer and other chronic diseases continues to grow, so does the need for health professionals to deliver effective disease prevention and screening recommendations.
July 11, 2017
As a radiation oncologist in London, Dr. David Palma spends a lot of his time speaking with patients about their treatment. But a personal experience helped him realize more needed to be done to inform patients about the importance of seeking out high-quality care, and to empower them to seek out the best care for their specific cancer. Palma, who is also an OICR clinician-scientist, just published a book called “Taking Charge of Cancer: What You Need to Know to Get the Best Treatment”, available in bookstores across North America. We spoke to Palma about the story behind the book, why such a book is needed and what he hopes to achieve with it. Palma is donating all royalties from the sales of the book to his local cancer foundation.
January 5, 2017
Are vasectomies safe? Some recent studies have found a link between vasectomies and the development of prostate cancer later in life. But new research using Ontario health data has challenged these studies and shown conclusively that there is no link, giving new peace of mind to those men who have undergone or are considering undergoing the procedure.
November 21, 2016
Family physicians are often a patient’s first point of contact in the healthcare system. For those patients with cancer, their family physician plays an important role in their care not just at their time of diagnosis, but also throughout their treatment and for the rest of their lives.
May 17, 2016
Dr. Eva Grunfeld named as Chair of new Canadian Institute of Health Research Institutes Advisory Board on Chronic Conditions
The Canadian Institutes of Health Research (CIHR) named Professor Eva Grunfeld as the inaugural Chair of the new Institutes Advisory Board (IAB) on Chronic Conditions. In her role, Grunfeld, Giblon Professor and Vice Chair (Research) at the Department of Family and Community Medicine at U of T, will help determine the future directions of research in chronic disease in Canada.
The management and prevention of chronic diseases in Canada represents one of the biggest challenges to our healthcare system
“It’s a great opportunity to contribute to the development of the new IAB structure – the aim of which is to improve integration across CIHR Institutes,” said Grunfeld, who is physician-scientist and Director of the Knowledge Translation Research Network, Health Services Research Program, at the Ontario Institute for Cancer Research. “Particularly with chronic conditions, it’s important to coordinate and cooperate across disciplines, across health conditions, and across research pillars. I’m looking forward to working with the other IAB chairs, IAB and members, and Institute Directors to impact research on chronic conditions in Canada.”