The new era of colon cancer screening is defined by personalization

Supporting a personalized approach to colon cancer screenings

Addressing colon cancer and screening options is a collaborative effort between healthcare professionals and patients or members – one where patient-specific paths of screening, evaluation, and testing feature personalized cancer screenings and conversations that align with individual patient needs.

Clinicians and care managers need the right tools and content to take full advantage of their position as trusted advisors in colon cancer prevention. Healthcare professionals should recommend colon cancer screening based on most recent evidence-based guidelines for both high- and average-risk patients. They will need support in addressing the most significant challenges to patient compliance, including stress reduction and facilitating increased patient comfort with bowel preparation and the inherent vulnerability of the procedure.

One of the most important physician considerations is individual patient expectations for receiving information — keeping in mind that patients want guidance from their care providers and can have preferences for care professionals being the primary decision-makers in their care choices.

Reducing no-shows through personalized communication

No-shows can be a difficult challenge for colorectal cancer screenings, particularly in gastrointestinal practices, where rates are higher than other specialties. This is frequently due to anxiety over the procedure and its preparation. But digital-first engagement programs can be used to support a personalized approach to care.

A recent study on digital navigation for bowel preparation found that text messages improved the quality of colorectal cancer screening by reducing no-show rates and improving preparation rates compared to usual care. A 2023 study additionally found that telephone should be added to electronic communication to reach groups with lower income levels and education. This can be an effective tactic in reducing CRC no-shows in certain groups. Predictors for no-shows of endoscopic gastrointestinal procedures include unpartnered status and having a non-commercial insurance provider.

Personalized paths feature new options in colon cancer screening and colonoscopy prep

Screening rates can also benefit from raised awareness of alternative options in screening and colonoscopy prep, including a new fecal immunochemical test (FIT), artificial intelligence (AI), and pills for bowel preparation.

FIT has become a popular option with patients but has struggled with issues around detecting advanced adenomas and advanced serrated polyps. An alternative, the antibody-based multitargetFIT (mtFIT), exhibits increased sensitivity that could position it as a viable option for certain patient groups. AI-assisted colonoscopies have also reduced the miss rate for colorectal neoplasia by 50%.

The emergence of broader options for patients is an opportunity for clinicians and care managers to have deeper discussions about colonoscopy prep — a hurdle that, if addressed, could support positive outcomes. In the past, patients had to drink almost a gallon of laxative fluids at once to prepare for the procedure. Today, patients and members have options that are not only more palatable, but that can be broken into smaller doses and stretched over two days. Many patients also prefer pill prep over traditional liquids.

Other options for improving screening rates could include increasing awareness of sedation-free colonoscopy. While sedation is the norm in the U.S., Singapore, and Hong Kong, in Finland only 6% of colonoscopies are performed with sedation. In Italy, 45% of patients did not have sedation or analgesia during their colonoscopy. China uses sedation in around 18% of procedures.

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