Improving COLON CANCER screening

As a pharmacist, you'll see more emphasis on improving colon cancer screening, since only 65% of eligible adults have been screened as recommended. A lot of this is being driven by quality measures. More health systems and physicians will be evaluated on what proportion of their eligible patients are current with screening. Your patients and colleagues will need and benefit from your help. Firstly identify patients and recommend that patients get screened starting at age 50 or sooner if at risk due to family history.

     Describe the tests. Many experts prefer colonoscopy, the entire colon can be seen and precancerous polyps can be removed at the same time. Flexible sigmoidoscopy and fecal occult blood tests are options, especially if the patient is wary of a colonoscopy or it's not available. The new "pill camera" and CT colonography have more limited indications.

Improve the bowel preparation. Explain that a clean colon improves visibility of polyps and can avoid the need to redo a colonoscopy. Advise avoiding red or purple liquids during the bowel preparation. To make PEG with electrolyte solutions (MoviPrep, etc) more palatable, suggest chilling, adding lemon juice or using a straw. When possible, suggest a "split-dose" regimen.. to improve prep quality AND tolerability. In this case, tell patients to take half the prep the evening prior and half about 4 to 6 hours before the procedure. If 4 L of PEG is too much to drink, suggest a low-volume prep (MoviPrep, etc) or oral bisacodyl plus 2 L of generic PEG to cut cost.

Work with prescribers to avoid medication problems. Most medications can be taken with a sip of water up to 3 to 4 hours before a colonoscopy. Explain that low-dose aspirin is usually okay, but antithrombotics, NSAIDs, iron, and fish oil may need to be held for up to a week prior. Insulin or sulfonylurea doses are often cut in half on prep day depending on blood glucose. The day of the procedure, suggest giving half the dose of BASAL insulin (Lantus, etc) if needed and holding other diabetes medications until the patient starts eating again.

REFERENCES

• Burt, R.W., Cannon, J.A., with others and National comprehensive cancer network (2013). Colorectal cancer screening. Journal of the National Comprehensive Cancer Network: JNCCN, [online] 11(12), pp.1538–1575. Available at: https://pubmed.ncbi.nlm.nih.gov/24335688

  Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. (2008). Annals of Internal Medicine, 149(9), p.627. Available at: https://pubmed.ncbi.nlm.nih.gov/18838716

  Hassan, C., Bretthauer, with others and European Society of Gastrointestinal Endoscopy (2013). Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy, [online] 45(2), pp.142–150. Available at: https://pubmed.ncbi.nlm.nih.gov/23335011