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Journal of Family Practice Oncology

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Journal of Family Practice Oncology Journal of Family Practice Oncology Issue Number 22, Spring 2014 | www.fpon.ca Insight into BC’s Colon Screening Program By Dr. Jennifer Telford, Medical Director, Registering eligible patients into the program Provincial Colon Screening Program ensures that the BC Cancer Agency receives FIT results and can refer patients with an Since November 15, 2013 the Colon abnormal FIT or those that are higher than Screening Program has been available average risk to one of 20 health authority across the province. Physicians can register patient coordinators for pre-colonoscopy asymptomatic patients ages 50 to 74 in the assessments. Colon Screening Program as follows: Abnormal FIT Results Colon Screening Program For average risk patients: Jennifer Telford MD MPH FRCPC February 20, 2014 FECAL IMMUNOCHEMICAL TEST (FIT) An abnormal FIT indicates that there www.screeningbc.ca/colon may be bleeding from somewhere in the • Select the ‘Fecal Occult Blood, age 50- colon or rectum. Blood can be present 74, asymptomatic q2y (copy to Colon in the stool for many different reasons, Watch Dr. Jennifer Telford’s hour long Screening Program)’ option on the including hemorrhoids, ulcers, anal fissures, Webcast on the BC’s new Provincial updated Standard Outpatient Laboratory diverticular disease, or inflammation. Colon Screening Program at www.fpon.ca Requisition. – CME Initiatives. • A copy of the FIT report will be sent to the Approximately 15% of individuals screened with Colon Screening Program at the BC Cancer FIT will have an abnormal FIT result and will Agency. require colonoscopy. Of those with an abnormal • For colorectal cancer screening in FIT, 4% will have cancer and approximately 60% individuals less than 50 years of age. • If the FIT result is abnormal, the BC Cancer will have a pre-cancerous polyp, an adenoma. Agency will facilitate the patient’s referral • For colorectal cancer screening in Most adenomas will not progress to cancer, to the appropriate health authority for individuals over 74 years of age. and for those that do, it will take many years colonoscopy. – Individuals 75-85 years can be for this transition to occur, which is why evaluated on a case-by-case basis • Physicians do not have to complete the patients should be screened regularly. Colonoscopy Referral Form for patients • For screening individuals who are in poor with abnormal FIT results if the Colon When is FIT not appropriate? health. If a patient is not medically fit to Screening Program is copied on the lab undergo colonoscopy, then they should FIT is recommended for individuals aged 50 to report. not undergo FIT. 74. FIT is not recommended in the following continued on page 2 For higher than average risk patients: situations: SCREENING COLONOSCOPY • Use the Colon Screening Program Join us for Family Practice Oncology CME Day on Nov. 1 Colonoscopy Referral Form to refer Please mark November 1 on your calendar as a great opportunity to gain the latest patients with at least one of the following: knowledge on the some of the most important topics in primary care oncology. This is the – One first degree relative diagnosed with date of the Network’s annual Family Practice Oncology CME Day to be held once again colorectal cancer diagnosed under the at the BC Cancer Research Centre. We promise insightful presentations age of 60. from leading oncologists; case-based workshops on colorectal – Two or more first degree relatives with screening, advanced cancers and side-effect management of cancer colorectal cancer diagnosed at any age treatment; plus the chance to reconnect with colleagues and save the date – A personal history of adenoma(s). contacts from throughout BC. Registration will open this summer – An abnormal FIT result when the Colon at www.fpon.ca. Hope to see you there! saturday Screening Program was not copied on november Contact Jennifer Wolfe at [email protected]. the lab report. 1 CCOPE workshop success — more planned in 2014 Cancer Care Outreach Program the workshop delivery coincided on Education (CCOPE) is an with the release of the new Colon Workshop evaluation data: I am confident that I can provide ongoing partnership between Screening Program, we were patients with care and information regarding colorectal cancer the UBC Division of Continuing able to address questions about that is based on provincial guidelines / recommendations and Professional Development the new screening processes best practice approaches to care (n=122) 50% 47% (UBC CPD), the BCCA Screening and procedures in various 44% Groups, and Family Practice communities; read more about 40% Oncology Network (FPON). The the screening program on page 1. 30% overall aim of the program is to support BC family physicians CCOPE 2014 20% in providing best practice care Following the success of the 10% 7% along the cancer continuum. CCOPE program to date, breast, 0% 2% 0% colorectal and prostate cancer Strongly Disagree Neutral Agree Strongly Agree disagree Colorectal Cancer modules will be updated and Workshops redelivered to 15 BC communities Testimonials: as Mainpro-C workshops Ten, two-part Mainpro-C “Informed discussion combined with excellent course material”. workshops on colorectal cancer this year. Another module “Open discussion of cases. Helpful to hear from colleagues were rolled out throughout BC on family physicians’ role in regarding their issues”. this winter, with the last follow- advanced cancer is also under up session held in Creston, development. Full details will be “Group discussion was most effective. Allowed to appreciate BC in early March. This is the made available at www.ubccpd. spectrum of current care”. third module of our community ca/oncology-program. oncology workshop series and was very well attended with Want CCOPE in 132 participants across all Your Community? communities. The workshop If you are a GPO or physician format was well received and interested in bringing a CCOPE participants’ confidence on workshop to your community, colorectal cancer care increased; please contact Jennie Barrows at a snapshot of evaluation data [email protected], 604.875.8075. is included here. In addition, as Insight into BC’s Colon Screening Program continued from page 1 Did You Know? • For individuals in a colonoscopy surveillance program. • In 2013 there were estimated to be approximately 1,700 males and 1,300 females diagnosed with colorectal cancer in BC. • For individuals up to date with colorectal screening. • In 2011, 2,912 people in British Columbia were diagnosed with colorectal cancer. – FIT within the last 2 years. • In 2011, 1,069 people in British Columbia died of colorectal cancer. – Colonoscopy or flexible sigmoidoscopy About the Provincial Colon Screening Program within the last 10 years for average risk. • The full program launched province wide on November 15, 2013– linking FIT with • For individuals with inflammatory bowel the BC Cancer Agency, Health Authority Patient Coordinators, and a monitoring and disease. reminder system. • For individuals with gastrointestinal • The Medical Services Plan (MSP) has paid for 305,000 FIT tests so far in 2013/14, symptoms. and expects to pay for more than 400,000 tests during the next fiscal year. For more information about the Colon • Over 500 patients with abnormal FIT results have been referred to the 23 patient Screening Program, and to request or coordinators around the province since the November launch. download the FIT requisition or colonoscopy referral form visit www.screeningbc.ca/colon. 2 FAMILY PRACTICE ONCOLOGY NETWORK JOURNAL / SPRING 2014 Update on the management of oral mucositis By Dr. Allan Hovan, DOs Provincial Professional Practice Leader, Oral Oncology webcast with Dr. Allan Hovan • Treat pre-existing dental problems Program in Oral Oncology/Dentistry, To learn more about this topic, take part (cavities, gum disease, infections, BC Cancer Agency Vancouver Centre in our May 15 Webcast, 8 - 9:00 a.m., PST. broken/sharp teeth, etc.). Register for this complimentary, nationally Oral mucositis (OM) is one of the most • Establish comfort and excellent fit of any accredited session at www.ubccpd.ca/ significant adverse side-effects of cancer removable dentures; leave dentures out Events/Webinar_Program.htm therapy and yet tends to be under-reported if mouth becomes sore during cancer by patients and under-treated by physicians therapy. • There is no evidence that mucosal and dentists. OM is a significant quality of life • Maintain good fluid intake; eat bland, soft coating agents, antimicrobial lozenges issue for patients and their families. Left foods while maintaining adequate protein or antibacterial rinses will be helpful in untreated, it can lead to high levels of and vitamin levels in the diet. anxiety, depression and social isolation as preventing OM. • Maintain meticulous oral hygiene during well as cause delays or interruptions in the course of cancer therapy. Based on this systematic review, the cancer therapy delivery. following strategies should be considered for DON’Ts chemotherapy-induced OM: • Avoid commercially-available • There is some evidence to support the mouthwashes use of ice chips (cryotherapy) for the prevention of OM, particularly when • Avoid spicy, acidic or coarse food products patient s are receiving bolus 5-FU or high- • Do not consume alcohol and don’t smoke dose melphalan as part of the conditioning Over the last several years, the Mucositis for stem cell transplantation. Study Group of the Multinational Association • Keratinocyte Growth Factor (Palifermin) of Supportive Care in Cancer (MASCC) has has been found to be beneficial for the updated evidence-based guidelines for OM prevention of all categories of OM; in management. The first MASCC/ISOO particular for patients receiving high-dose Good oral hygiene remains the mainstay of guidelines were published in the journal chemotherapy and total body irradiation therapy for oral mucositis. Cancer in 2004 and the first update of these (TBI) for treatment of hematologic OM is common during high-dose H&N guidelines was described in publications in malignancies with stem cell transplant.
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