New Approaches to Improving Colonoscopy for Colon Cancer Screening with Neil Sengupta, MD
by Anna Gomberg
The tragic death from colon cancer of beloved actor Chadwick Boseman—best known for portraying the iconic Black Panther character in Marvel movies – shocked and saddened the world this August. He was only 43. Colon cancer is one of the leading causes of cancer-related death in the United States and worldwide. For many, Boseman’s passing was a reminder of the importance of colon cancer screening and early detection.
One of the most important tools for screening for colon cancer is colonoscopy. While the procedure itself is typically done under sedation with relative ease and comfort, some patients find preparation for a colonoscopy unpleasant and difficult, not to mention complicated. Preparation requires coordination with the procedure team and gastroenterologist, all while managing life at home.
Neil Sengupta, MD, gastroenterologist and Assistant Professor of Medicine of the University of Chicago is interested in how physicians can improve delivery of this important care and make the patient experience easier to tolerate.
He explains, “In order to benefit from colon cancer screening, a patient needs to have a high-quality screening examination. There are three variables that determine a high-quality colonoscopy. First, patients need to schedule and come in for their procedure. Endoscopy units have staggeringly high “no-show” rates, which leads to missed opportunities to screen patients. Second, patients need to have a good quality bowel preparation. In order for providers to visualize polyps at the time of colonoscopy, the bowel needs to be cleansed with a laxative, and there’s a good amount of evidence that shows the better the quality of the cleanout, the better the chance a doctor has to find polyps and reduce the risk of colon cancer. Third, a patient’s procedure needs to be performed by a provider very skilled in endoscopy.”
Sengupta and his colleagues use a variety of strategies to improve all three components of colonoscopy quality. To reduce attrition at patient appointments and improve preparation, the UChicago Digestive Diseases team is investigating novel outreach methods to reach patients and guide them through every step of their procedure.
“We’ve traditionally relied on paper handouts and nurses making phone calls to describe how to take a bowel preparation and when to arrive for the procedure,” Sengupta explained. “We are currently actively investigating novel outreach methods to reach patients to guide patients through every step of their colonoscopy. For example, we’re using text messages: we enroll patients who are scheduled for a colonoscopy, and we text them through every step of the process. We tell them what bowel preparation to use, when to arrive for their procedure, when to take the first half of their preparation, when to take the second half, and so on. Upgrading these methods of communication can support patients to improve their outcomes and them make it their appointments.”
To improve the skill of providers at detecting cancer, researchers need data to establish baselines. The adenoma detection rate (ADR) is the percentage of time a provider finds a precancerous polyp at the time of colonoscopy, and is an objective measure of an individual provider’s success in preventing colon cancer in the future. Sengupta explains that this is a critical, if labor-intensive way to measure quality, because it involves communication across different software programs and extensive documentation.
Says Sengupta, “Through the support of GIRF, we now have the resources to track this for our providers, and actually determine how well we are doing at preventing colon cancer to save lives—always our ultimate goal.”