Burden of waiting for surveillance CT colonography in patients with screen-detected 6-9 mm polyps

Abstract

Purpose: We assessed the burden of waiting for surveillance CT colonography (CTC) performed in patients having 6-9 mm colorectal polyps on primary screening CTC. Additionally, we compared the burden of primary and surveillance CTC.

Materials and methods: In an invitational population-based CTC screening trial, 101 persons were diagnosed with <3 polyps 6-9 mm, for which surveillance CTC after 3 years was advised. Validated questionnaires regarding expected and perceived burden (5-point Likert scales) were completed before and after index and surveillance CTC, also including items on burden of waiting for surveillance CTC. McNemar's test was used for comparison after dichotomization.

Results: Seventy-eight (77 %) of 101 invitees underwent surveillance CTC, of which 66 (85 %) completed the expected and 62 (79 %) the perceived burden questionnaire. The majority of participants (73 %) reported the experience of waiting for surveillance CTC as 'never' or 'only sometimes' burdensome. There was almost no difference in expected and perceived burden between surveillance and index CTC. Waiting for the results after the procedure was significantly more burdensome for surveillance CTC than for index CTC (23 vs. 8 %; p = 0.012).

Conclusion: Waiting for surveillance CTC after primary CTC screening caused little or no burden for surveillance participants. In general, the burden of surveillance and index CTC were comparable.

Key points: • Waiting for surveillance CTC within a CRC screening caused little burden • The vast majority never or only sometimes thought about their polyp(s) • In general, the burden of index and surveillance CTC were comparable • Awaiting results was more burdensome for surveillance than for index CTC.

Keywords: Anxiety/epidemiology; Colonography, computed tomographic/methods; Colorectal neoplasms/diagnosis; Mass screening/methods; Pain measurement.

Fig. 1

Overview of response to the expected and perceived burden questionnaire (EBQ and PBQ) including Impact of Event Scale (IES) among 101 surveillance CT colonography participants. ^aFour passed away, ten underwent a colonoscopy prior to invitation for surveillance CT colonography, and nine did not wish to participate for various reasons. ^bCompleted the EBQ & IES-I and PBQ & IES-II in time (prior to the surveillance CT colonography and within 12 weeks of surveillance CT colonography, respectively)

Fig. 2

Thoughts on colonic polyps and experienced burden in the period between the index and surveillance CT colonography (the past 3 years). Anxiety and expected burden while waiting for (the results of) surveillance CT colonography

Fig. 3

Reluctance to undergo index (screening) CT colonography and surveillance CT colonography, and expected embarrassment, pain, and burden of bowel preparation and CT colonography of both examinations. P values of McNemar’s test after dichotomization are presented on top of the bars

Fig. 4

Perceived burden of the entire CT colonography examination, waiting for the CT colonography results and entire screening procedure with surveillance CT colonography, in comparison to index CT colonography. P-values of McNemar’s test after dichotomization are presented on top of the bars

Fig. 5

CRC-specific distress score (Impact of Event Scale [IES] total) over time. a Total IES scores for the total group, separated by gender. Total IES scores in women were significantly higher than for men prior to and after surveillance CT colonography (p = 0.006 and p = 0.012, respectively). b Total IES scores for the total group, separated by result of the surveillance CT colonography. Total IES score of the group with a positive CT colonography result increased (p = 0.006). Total IES scores of the group with a negative result decreased (p = 0.655)

Fig. 6

General statements on bowel cancer screening in index and surveillance CT colonography. P-values of McNemar’s test after dichotomization are presented on top of the bars

Fig. 7

Perceived burden of bowel preparation and different aspects of surveillance CT colonography in comparison to index CT colonography. P-values of McNemar’s test after dichotomization are presented on top of the bars