COLORECTAL CANCER SCREENING: A NON-INVASIVE APPROACH Amy Frazier May, 2004 58 Pages Directed by: Dr. Donna Blackburn, Dr. Patricia Bailey, and Dr. Thomas Nicholson Department of Nursing Western Kentucky University Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide and is expected to affect six percent of Americans within their lifetime (National Cancer Institute, 2003). Clinicians worldwide struggle with selecting the most accurate, cost-effective CRC screening tool. Could a noninvasive screening tool be the answer or part of the answer to the dilemmas surrounding CRC screening? The purpose of this correlational, replication study was to determine whether symptoms such as rectal bleeding, change in bowel habit, and weight loss are associated with symptomatic colorectal cancer using a sample of individuals scheduled for a routine colonoscopy. This study can be considered a pilot study since it has never been replicated in the United States (U.S). Data obtained from 47 Bowel Symptom Assessment Questionnaires (BSAQs) given to patients undergoing routine colonoscopy at Greenview Regional Hospital in Bowling Green, Kentucky were analyzed to address the research objectives of the study. None of the patients had colorectal cancer, but 15 of the 47 patients had polyps. None of the symptoms showed a significant correlation with polyps according to chi-square analysis. T-tests of the means of the polyp group versus the no polyp group showed no difference between the population means for each of the examined variables. Selva scores generated from the BSAQ did not show a 8 significant relationship with the presence or absence of polyps. Additional findings, limitations, and implications for future research are discussed.

Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / BACKGROUND: Effective colorectal cancer prevention programs should ensure that patients with adenomas receive timely surveillance colonoscopy consistent with guidelines. The aim of our study was to identify patient-, provider-, and system-level predictors of adherence with surveillance colonoscopy in an ethnically diverse safety-net population. METHODS: We performed a retrospective analysis of average-risk patients age 50-75 with adenomas diagnosed at screening colonoscopy at Boston Medical Center and its affiliated community health centers from 1/1/2005 to 12/31/2007. The primary outcome was on-time follow-up defined as attendance at surveillance colonoscopy within 5.5 years of the screening colonoscopy. We compared frequencies of on-time follow-up and performed multivariable analysis, including ethnicity/language and any variable with P value <0.20 in unadjusted analysis. RESULTS: We identified 891 patients, of which 38% were English-speaking Non-Hispanic blacks, 24% Non-Hispanic white, and 10% Spanish-speaking Hispanics. Overall, 38.2% attended on-time surveillance colonoscopy. In unadjusted analyses, having ≥3 PCP visits in year 3-5 after baseline colonoscopy (OR 3.6 [2.6-5.1]), having “adenoma” on the electronic medical record problem list (OR 2.2 [1.6-2.9]), age (OR 0.98 [0.96-1.0]), and Charlson Index ≥1 (OR 1.3 [1.0-1.8]) were positively associated with adherence. In multivariate analysis, having “adenoma” on the problem list remained significant (adjusted OR (aOR) 1.8 [1.3-2.5]). Significant interactions were observed for ethnicity/language and PCP visits (P=0.008). CONCLUSION: A substantial proportion of adenoma-bearing patients fail to attend surveillance colonoscopy even in a safety net setting. Adding “adenomas” to the EMR problem list improved attendance, suggesting that system-level interventions may increase adherence to surveillance colonoscopy. / 2031-01-01