P229 Post-colorectal cancer resection colonoscopy: factors associated with compliance. (19th June 2022) - Morley, Olivia
Abstract : Introduction: The British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines for surveillance post-colorectal cancer (CRC) resection emphasise the role of clearance colonoscopy (CC) 1-year after diagnosis (Cairns et al. 2010; Rutter et al. 2019), with aim to identify metachronous neoplasia, thus reducing CRC-related mortality. This study aimed to assess patient demographic, socioeconomic, and clinician factors related to non-adherence with post-CRC resection surveillance. Methods: A retrospective observational cohort study was performed of patients with histologically confirmed CRC at a London district general hospital between 2009 and 2018. Patients with non-curative CRC or those deceased at 15 months were excluded from the study. Patients who did not have 1-year CC (12+3 months) were identified and categorised as: non-attendance; unfit for colonoscopy; delayed or not booked by clinicians. Statistical analysis was performed with Stata v17 of patient factors including age, gender and Oxford Index of Multiple Deprivation (IMD) score derived from the patients' post-codes as a surrogate marker for socioeconomic status. Results: In total 219 patients had CRC resection with curative intent therefore should have undergone 1-year CC. Only 67 patients (30.6%) had their CC within this hospital provider within the recommended timeframe, and 73 patients (33.3%) received their CC after 15 months. The delays in CC ranged from 1 to 71 months from the date CC was due, with a mean delay of 16 months. A further 60 patients (27.4%) had not received CC at time of data collection. The remaining 8.7% had their care transferred to a different hospital, or declined follow-up. The median age in the surveillance-adherent cohort was 65 (range 33-87) versus 72 (range 34-93) years in the non-adherent cohort (p=0.09 T-test). Gender was not associated with episode compliance (p=0.5 Chi-squared test). Socioeconomic status defined by IMD score was not associated with episode compliance (p=0.33, T-test). Conclusions: Our results demonstrate that a significant number of patients may not receive 1-year post-CRC resection surveillance in accordance with BSG/ACPGBI guidelines. Age, gender and IMD score are not significantly associated with compliance with 1-year post-CRC CC, suggesting that clinician factors could be an important factor. Increased awareness of CRC surveillance guidelines within the medical team and development of systematic follow-up processes may reduce risk of late detection of synchronous or metachronous colorectal cancer.