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Intervention programme does not improve screening rates
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Intervention programme does not improve screening rates An intervention programme aimed at improving rates of colorectal-cancer screening in a set of managed-care practices across California, USA, failed to do so, research in Cancer shows (published online Oct 10, 2005; DOI: 10.1002/cncr.21434). “Only 26% of individuals eligible to receive colorectal-cancer screening received it. Screening rates for colorectal cancer are extremely low, even in a setting where patients have access to care (eg, insured) and have been to see their doctor for a regular physical examination”, Patricia Ganz (University of California, Los Angeles, CA, USA) explained. Ganz and colleagues helped 19 managed-care practices across California use various tools and strategies to increase participation in screening for colorectalcancer. The intervention included a 2-h workshop for providers and staff, provision of educational material, and assistance with a chart audit to assess
current screening rates and quality of chart documentation. 17 practices received no intervention. After 2 years, participation in screening for colorectalcancer did not differ between individuals selected from intervention and control practices (26·4% vs 26·3%). Furthermore, more than 70% of patients had not been screened for colorectal cancer within the guidelines (past year for faecal occult blood test, 5 years for flexible sigmoidoscopy, 10 years for colonoscopy). Individuals who were older than 60 years, received care in an integrated medical practice, and had had a physical examination within the past 2 years were more likely to undergo colorectal-cancer screening within the recommended times. “Colorectal-cancer screening needs to be a strong priority for all involved, including patients, providers, healthcare organisations, insurance plans, and society”, Ganz said.
Stephen Taplin (National Cancer Institute, Bethesda, MD, USA), notes that this study is very important because it reports negative findings, which are rarely published. “This was an effectiveness study but the key missing ingredient was a person in each organisation who could champion the process. Although they intended to have this person, the disruption and competing priorities within organisations meant that the person could rarely provide the needed leadership within the organisation”, he explained. This study, Taplin says, shows the importance of the health-care environment and of organisational leadership to achieving success. “The question it raises is how we achieve that organisation and leadership in a conscious way in the face of the competing demands that health-care organisations face”, he concluded.
Khabir Ahmad
Kidney transplantation increases risk of melanoma
©Anatomical Travelogue/Science Photo Library
People who have had a kidney transplantation and are receiving immunosuppressive drugs are more than three times as likely to develop melanoma as healthy people, according to research in Cancer (published online Sept 26, 2005; DOI: 10.1002/cncr.21404). In African Americans, who rarely develop melanoma, the risk could be more than 17 times as great.
Immune surveillance is reduced after kidney transplantation
830
Kidney transplantation has long been associated with an increased risk of non-melanoma skin cancer: the drugs used to prevent rejection have the drawback of reducing immune surveillance, giving cancers more of a chance to take hold. “However, the picture with melanoma was less clear”, explains Christopher Hollenbeak (Penn State College of Medicine, Hershey, PA, USA). “Some authors found that kidney-transplantation patients were at no greater risk of developing this malignancy, while others reported them to be at five times greater risk than the normal population.” Hollenbeak’s team assessed the medical records of nearly 90 000 US citizens who had had kidney transplantations between 1988 and 1998. 246 of these people developed melanoma, an age-adjusted rate of 55·9 cases per 100 000 patients,
3·6 times the rate seen in people who had not received a transplantation. “We also saw that the risk increased with age”, explains Hollenbeak. “This might be an additive effect of the normal, age-associated risk of developing melanoma, although it was worse in men than in women, perhaps suggesting a hormonal component. People who had had problems with organ rejection at least once seemed to be at a slightly higher risk again, perhaps because their immunosuppression was stepped up.” “These results show the need to take a preventive attitude”, remarks Miguel Ángel Gentíl (Hospital Vírgen del Rocio, Seville, Spain). “It is important that patients who receive a transplantation be taught how to examine themselves, and follow-up should include periodic visits to a dermatologist.”
Adrian Burton
http://oncology.thelancet.com Vol 6 November 2005
Intervention programme does not improve screening rates An intervention programme aimed at improving rates of colorectal-cancer screening in a set of managed-care practices across California, USA, failed to do so, research in Cancer shows (published online Oct 10, 2005; DOI: 10.1002/cncr.21434). “Only 26% of individuals eligible to receive colorectal-cancer screening received it. Screening rates for colorectal cancer are extremely low, even in a setting where patients have access to care (eg, insured) and have been to see their doctor for a regular physical examination”, Patricia Ganz (University of California, Los Angeles, CA, USA) explained. Ganz and colleagues helped 19 managed-care practices across California use various tools and strategies to increase participation in screening for colorectalcancer. The intervention included a 2-h workshop for providers and staff, provision of educational material, and assistance with a chart audit to assess
current screening rates and quality of chart documentation. 17 practices received no intervention. After 2 years, participation in screening for colorectalcancer did not differ between individuals selected from intervention and control practices (26·4% vs 26·3%). Furthermore, more than 70% of patients had not been screened for colorectal cancer within the guidelines (past year for faecal occult blood test, 5 years for flexible sigmoidoscopy, 10 years for colonoscopy). Individuals who were older than 60 years, received care in an integrated medical practice, and had had a physical examination within the past 2 years were more likely to undergo colorectal-cancer screening within the recommended times. “Colorectal-cancer screening needs to be a strong priority for all involved, including patients, providers, healthcare organisations, insurance plans, and society”, Ganz said.
Stephen Taplin (National Cancer Institute, Bethesda, MD, USA), notes that this study is very important because it reports negative findings, which are rarely published. “This was an effectiveness study but the key missing ingredient was a person in each organisation who could champion the process. Although they intended to have this person, the disruption and competing priorities within organisations meant that the person could rarely provide the needed leadership within the organisation”, he explained. This study, Taplin says, shows the importance of the health-care environment and of organisational leadership to achieving success. “The question it raises is how we achieve that organisation and leadership in a conscious way in the face of the competing demands that health-care organisations face”, he concluded.
Khabir Ahmad
Kidney transplantation increases risk of melanoma
©Anatomical Travelogue/Science Photo Library
People who have had a kidney transplantation and are receiving immunosuppressive drugs are more than three times as likely to develop melanoma as healthy people, according to research in Cancer (published online Sept 26, 2005; DOI: 10.1002/cncr.21404). In African Americans, who rarely develop melanoma, the risk could be more than 17 times as great.
Immune surveillance is reduced after kidney transplantation
830
Kidney transplantation has long been associated with an increased risk of non-melanoma skin cancer: the drugs used to prevent rejection have the drawback of reducing immune surveillance, giving cancers more of a chance to take hold. “However, the picture with melanoma was less clear”, explains Christopher Hollenbeak (Penn State College of Medicine, Hershey, PA, USA). “Some authors found that kidney-transplantation patients were at no greater risk of developing this malignancy, while others reported them to be at five times greater risk than the normal population.” Hollenbeak’s team assessed the medical records of nearly 90 000 US citizens who had had kidney transplantations between 1988 and 1998. 246 of these people developed melanoma, an age-adjusted rate of 55·9 cases per 100 000 patients,
3·6 times the rate seen in people who had not received a transplantation. “We also saw that the risk increased with age”, explains Hollenbeak. “This might be an additive effect of the normal, age-associated risk of developing melanoma, although it was worse in men than in women, perhaps suggesting a hormonal component. People who had had problems with organ rejection at least once seemed to be at a slightly higher risk again, perhaps because their immunosuppression was stepped up.” “These results show the need to take a preventive attitude”, remarks Miguel Ángel Gentíl (Hospital Vírgen del Rocio, Seville, Spain). “It is important that patients who receive a transplantation be taught how to examine themselves, and follow-up should include periodic visits to a dermatologist.”
Adrian Burton
http://oncology.thelancet.com Vol 6 November 2005