Venue: St Mark’s Hospital, London
Target Audience: All members of the Colorectal Cancer MDT (nurse specialists, oncologists, gastroenterologists, colorectal surgeons, pathologists), Geneticists, genetics counsellors
Learning Style: Lectures and case discussions
Learning Outcomes: On completion of this course, attendees will:
£150.00 – Consultants
£75.00 – Nurses, Trainees and other Healthcare Professionals
A new study has just been published in the journal Frontline Gastroenterology. This shows a highly inconsistent approach to the management of patients at elevated risk of hereditary colorectal cancer (CRC) in the United Kingdom (UK).
The British Society of Gastroenterology (BSG) Cancer Group designed a national survey to determine how we might understand and improve the service for these patients.
What is already known on this topic? Genetic factors contribute about 35% of all colorectal cancer (CRC) risk. There is good evidence that the correct management of patients with an elevated hereditary risk is a highly effective method of preventing CRC. This can be achieved by screening according to guidelines and the development of a high quality service with clear patient pathways. However in some studies there is evidence of an inconsistent approach to the management of those patients, with low risk patients being screened too often, and high risk patients not frequently enough. There is also a low referral rate to genetic services for high risk patients.
What this study adds? Responses to this national survey suggest a poor understanding of the current guidelines amongst clinicians and variable clinical pathways for patients. There is also a perception that another unspecified clinician is undertaking this work. This may explain the wide variation in care and low adherence to guidelines in the United Kingdom (UK).
How might it impact on clinical practice in the foreseeable future? We recommend the development of clear structures and the provision of a high quality service to these patients through national audit, development of quality standards and education of physicians and surgeons in the UK. Each hospital should develop a lead clinician for the delivery of these services. Only in this way will this ad hoc approach to the management of hereditary CRC be improved.
Objectives: The British Society of Gastroenterology (BSG) Cancer Group designed a survey to determine how we might understand and improve the service for patients at elevated risk of hereditary colorectal cancer (CRC).
Design and Setting: United Kingdom (UK) gastroenterologists, colorectal surgeons, and oncologists were invited by email to complete a 10 point questionnaire. This was cascaded to 1,793 members of the Royal College of Radiologists (RCR), Association of Cancer Physicians (ACP), the Association of Coloproctology of Great Britain and Ireland (ACPGBI), as well as BSG members.
Results: Three hundred and eighty-two members responded to the survey, an overall response rate of 21.3%. Although 69% of respondents felt there was an adequate service for these higher risk patients, 64% believed that another clinician was undertaking this work. There was no apparent formal patient pathway in 52% of centres, and only 33% of centres maintain a registry of these patients. Tumour block testing for Lynch Syndrome is not usual practice. Many appeared to be unaware of the BSG/ACPGBI UK guidelines for the management of these patients.
Conclusions: There is wide variability in local management and in subsequent clinical pathways for hereditary CRC patients. There is a perception that they are being managed by ‘another’, unspecified clinician. National guidelines are not adhered to. We therefore recommend improved education, well defined pathways and cyclical audit in order to improve care of patients with hereditary CRC risk.
Our new study shows that we can do much more to identify patients with Lynch syndrome in the UK. We already know that diagnosing Lynch syndrome can affect the treatment of a patient with bowel cancer – and can save the lives of their family members. Every team dealing with bowel cancer patients needs to routinely discuss the possibility of an inherited cancer syndrome. This study has just been published in the journal ‘Frontline Gastroenterology’.
Lynch syndrome is the most common familial bowel cancer syndrome. European guidelines suggest selective screening of appropriate colorectal cancer patients, according to the revised Bethesda criteria. Many eligible patients do not undergo the necessary investigation.
What this study adds
This is the first time that UK practice in this area has been evaluated. Our patients are assessed haphazardly for Lynch syndrome, and we do not follow international guidance. This will lead to under-diagnosis and missed opportunities to reduce cancer mortality. impact on clinical practice in the foreseeable
Colorectal cancer teams should incorporate a revised Bethesda assessment into the routine discussion of each new patient. They should develop screening and referral pathways with their local genetics services. This aspect of their work can be audited and may become a quality standard in the future.
The “Family History of Bowel Cancer” clinic at the West Middlesex University Hospital, led by Dr Kevin Monahan, helps assess patients with a significant family background of cancers. Patients, GPs and other health professionals can read more about our service, and how to make a referral, at https://familyhistorybowelcancer.wordpress.com.
We offer access to information, advice and support within a non-clinical and welcoming environment to all those affected by the diagnosis of cancer.
The Family History of Bowel Cancer Clinic
Twickenham Road, Isleworth,
London TW7 6AF.
Telephone: 020 8321 5351
Fax: 020 8321 5152
We are an award winning major acute hospital in Isleworth, West London, providing a full range of hospital services to residents of the London Boroughs of Hounslow and Richmond upon Thames.
Our vision is to be a first class hospital for our community and to provide high quality care in every way.
Specialist clinics for hepatology (liver disease) and inflammatory bowel disease (ulcerative colitis
and Crohn’s disease)
Outpatient Department 4 and Endoscopy are both located on the ground Floor, East Wing.
Dr Kevin Monahan – Consultant Gastroenterlogist. Tel: 020 8321 5352 / fax 020 8321 5152
Dr Carole Collins – Physician & Gastroenterologist. Tel: 020 8321 5351 / fax 020 8321 5152
Dr Iain Beveridge – Physician & Gastroenterologist. Tel: 020 8321 5352 / fax 020 8321 5152
Dr Krishna Sundaram – Physician & Gastroenterologist. Tel: 020 8321 5351 / fax 020 8321 5152
Dr Joel Mawdsley – Physician & Gastroenterologist. Tel: 020 8321 5351 / Fax: 020 8321 5152
Lynne McEvoy. Tel: 020 8321 6139.
Referrals can be made via Choose & Book or by letter. Urgent referrals can be made via fax 020 8321 5152
Tel: 020 8321 5351/5352 Gastroenterology 020 8321 5152 Endoscopy 020 8321 5753
National Bowel Cancer Awareness Programme – Referrals to Seconday Care
British Liver Trust: www.britishlivertrust.org.uk
Coeliac UK: www.coeliac.co.uk
CORE – charity for research and information on gut and liver disease: www.digestivedisorders.org.uk
National Association for Colitis and Crohn’s Disease (NACC): www.nacc.org.uk
Patient information leaflets are provided in advance for all patients who attend the department for a procedure.
Click here to access our Gastroenterology patient information website