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ABSTRACT BACKGROUND Colorectal cancer (CRC) is a worldwide health problem whose control depends on public policy establishment and effective prevention and screening programs. In Brazil, there are few studies related to adherence to screening methods. AIMS: The aim of this study was to evaluate the association between demographic and socioeconomic to adherence to CRC screening with fecal immunochemical test (FIT) among average-risk individuals for CRC. METHODS: In this prospective cross-sectional study, conducted between March 2015 and April 2016, 1,254 asymptomatic individuals aged 50-75 years, participating in a hospital screening campaign in Brazil, were invited to participate in the study. RESULTS: The adherence rate to FIT was 55.6% (697/1,254). In the multivariable logistic regression analysis, patients aged 60-75 years (odds ratio (OR)=1.30; 95% confidence interval (CI): 1.02-1.66; p=0.03), religious belief (OR=2.04; 95% CI: 1.34-3.11; p<0.01), previous fecal occult blood test (OR=2.07; 95% CI: 1.55-2.76; p<0.01), and full/part-time working status (OR=0.66; 95% CI: 0.49-0.89; p<0.01) were independently associated with adherence to CRC screening. CONCLUSION: The results of the present study highlight the importance of considering the labor aspects when implementing screening programs, suggesting that campaigns conducted in the workplace and repeated over the years may be more effective.
RESUMO RACIONAL: O câncer colorretal (CCR) é um problema de saúde mundial cujo controle depende do estabelecimento de políticas públicas e programas de prevenção e rastreamento eficazes. No Brasil existem poucos estudos relacionados à adesão métodos de rastreamento. OBJETIVO: Avaliar a associação de características sócio-demográficas à realização de testes de sangue oculto nas fezes do tipo imunoquimicomecanizado (FIM) em população de médio risco para o desenvolvimento de câncer colorretal. MÉTODOS: Estudo observacional transversal, com coleta prospectiva de dados. Entre março de 2015 e abril de 2016, 1.254 indivíduos assintomáticos, com idade entre 50 e 75 anos, foram consecutivamente selecionados a partir de uma campanha hospitalar de rastreamento para neoplasias. RESULTADOS: As taxas de adesão ao teste FIM foi 55.6% (697/1254). Na análise de regressão logística múltipla os fatores independentes associados à adesão ao rastreamento do CCR foram: Idade entre 60-75 anos (oddsratio (OR)=1.30; intervalo de confiança de 95% (IC): 1.02-1.66; p=0.03), crença religiosa (OR=2.04; 95%IC: 1.34-3.11; p<0.01), realização prévia de exame de sangue oculto nas fezes (OR=2.07; 95%IC: 1.55-2.76; p<0.01) e vínculo empregatício em período integral ou parcial (OR=0.66; 95%IC: 0.49-0.89; p<0.01). CONCLUSÃO: Este estudo enfatiza a importância de considerar aspectos laborais ao implementar programas de rastreamento do câncer colorretal e sugere que campanhas de rastreamento implantadas no ambiente de trabalho e de maneira repetida ao longo dos anos podem ser mais efetivas.
RESUMO
Introdução: O câncer colorretal (CCR) é um problema de saúde pública mundial cujo controle depende do estabelecimento de políticas públicas e programas de prevenção e rastreamento eficazes. No Brasil estudos relacionados à adesão e preferências a diferentes métodos de rastreamento são pouco conhecidos. Objetivo: Avaliar a associação de características demográficas, condição socioeconômica e variáveis clínicas na adesão para realização de testes de sangue oculto nas fezes (PSOF) dos tipos Imunoquimico Mecanizado (FIT) e Guaiaco (G-FOBT) em população de médio risco para o desenvolvimento de câncer colorretal. Método: Estudo observacional transversal, com coleta prospectiva de dados. Entre março de 2015 e abril de 2016 1.254 indivíduos assintomáticos, com idade entre 50 e 75 anos, foram consecutivamente selecionados a partir de campanhas hospitalares de rastreamento para neoplasias conduzidas pelo AC Camargo Cancer Center. Todos os participantes foram convidados ao rastreamento do CCR mediante realização dos testes (G-FOBT) e (FIT) e responderam a um questionário com características demográficas, condição socioeconômica e variáveis clínicas. Análise estatística: Para avaliar a independência entre variáveis qualitativas foi aplicado o teste de Qui-quadrado. As médias das variáveis quantitativas foram comparadas através do Teste t. Os resultados das análises univariadas foram utilizados para selecionar variáveis para os modelos de regressão logística múltipla, considerando-se valores de p≤0.20. As associações estão descritas por Odds Ratio (OR) e o intervalo de confiança adotado foi de 95% (95% CI). A significância considerada foi de 0.05. A partir dos resultados encontrados foi proposto um nomograma para a predição da probabilidade de adesão com base nas características dos indivíduos. Resultados: As taxas de adesão foram 55,6% e 48,8%, respectivamente para os testes FIT e G-FOBT (p<0.001). As médias de anos de estudos foram diferentes entre os grupos aderentes e não aderentes nos métodos FIT e G-FOBT (8.4vs 9.0; p = 0.001). Nas análises univariadas, as variáveis idade, tipo de atividade ocupacional, crença religiosa e realização prévia de PSOF influenciaram as taxas de adesão aos dois tipos de testes. Nos modelos multivariados, respectivamente para os exames FIT e G-FOBT as variáveis idade 60-75 anos (OR = 1.39; 95%IC 1.061.81) e (OR = 1.49; 95%IC 1.161.49), presença de crença religiosa (OR = 1.99; 95%IC 1.273.11) e (OR = 1.70; 95% IC 1.112.60), PSOF (OR = 2.22; 95% IC 1.61 3.05) e (OR = 1.26; 95% IC 1.262.20) e trabalho em tempo integral ou parcial (OR = 0.69; 95% IC 0.050.96) e (OR= 0.68; 95%IC 0.500.91) estiveram associadas de forma independente à adesão aos métodos de rastreamento do CCR. As variáveis, sexo, raça, estado civil, renda, presença de seguro saúde e distância da residência até o hospital não influenciaram na adesão aos exames FIT e G-FOBT. Conclusão: Maior idade, presença de crença religiosa, ausência de atividade de trabalho formal e realização prévia de PSOF estão relacionados à maior adesão aos testes (FIT) e o (G-FOBT), na população estudada.
INTRODUCTION: Colorectal surgeries are complex procedures, associated with higher rates of complications and readmissions than procedures at other surgical sites. Currently, standardized procedures aim the early recovery of patients treated for colorectal surgeries in order to reduce the length of hospital stay. The reduction in hospitalization time, however, despite being considered a positive result, may lead to a risk , since complications generally occur outside the hospital environment, making it difficult to assess and monitor these patients. OBJECTIVE: The aim of the present study was to develop a mobile health app , accessible on smartphones, to remotely monitor the signs and symptoms of patients in the postoperative period of colorectal surgeries, evaluating the outcomes of admission rate in the emergency department and rate of severe complications. (Clavien-Dindo 3 to 5) within a fifteen-day postoperative period. METHODS: The project was developed in two steps, the first being the structuring of the Digital Journey, with the creation of a platform with a decision algorithm for identifying symptoms and directing conducts, and the second the validation of the program in a pilot study. Patients aged between 18 and 80 years old, who were to undergo oncological colorectal surgeries, were included in the study. The study was conducted on the premises of the A.C.Camargo Cancer Center. Monitoring of patients and reporting of signs and symptoms by patients were performed via a remote monitoring platform, using a smartphone or computer. RESULTS: In the pilot study, in each of the three evaluation phases of the data obtained, the decision algorithm and the instrument for data collection were restructured, aiming to achieve greater sensitivity and specificity in the detection of complications by the platform, as well as greater patient satisfaction. The ability to detect complications increased at each analysis and adjustment phase, and after the third and final phase of adjustments, 45 (71.4%) adverse events were reported, of which 12 (19%) were symptoms classified as high grade. In this sample, the digital solution was able to identify 3 (4.8%) real complications with a sensitivity of 75%, specificity of 84%, accuracy of 83%, positive predictive value of 25% and negative predictive value of 98%. We also had, 5(7.9%) errors in filling out detected and 1(1.6%) complications not detected by the platform, due to error in filling out the daily assessment questionnaire. Our rehospitalization rate by indication of the platform, in this sample was 2 (3.2%) and admission to the emergency room, considering referral or not from the platform, was 8 (12.7%). Complete adherence to the monitoring program was 83%, with an NPS score ranging from 69 to 95, the highest score obtained in the last evaluation phase. CONCLUSION: The a mobile health app created was proved to be safe, with high adherence rates and good acceptance by patients, but it still needs to be adjusted with the intention of reducing costs of referral and admission to the emergency department.
Assuntos
Humanos , Masculino , Feminino , Neoplasias Colorretais/cirurgia , Telemedicina , Período Pós-Operatório , Inteligência ArtificialRESUMO
INTRODUÇÃO: Cirurgias colorretais são procedimentos complexos, associados a maiores taxas de complicações e readmissões que procedimentos realizados em outros sítios cirúrgicos. Atualmente, medidas padronizadas visando à recuperação precoce de pacientes submetidos a cirurgias colorretais são adotadas com o objetivo de reduzir o tempo de internação hospitalar. A redução do tempo de internação, entretanto, apesar de ser considerada um desfecho positivo, pode propiciar risco de atraso de diagnóstico e deterioração clínica já que as complicações, geralmente acontecem fora do ambiente hospitalar, dificultando a avaliação e acompanhamento destes pacientes. OBJETIVO: O objetivo do presente estudo foi desenvolver um plano de seguimento pós-alta eletrônico, acessível em smartphones, para monitorar remotamente os sinais e sintomas de pacientes em pós-operatório de cirurgias colorretais, avaliando os desfechos de taxa de admissão no setor de emergência e taxa de complicações graves (Clavien-Dindo 3 a 5), no período de quinze dias de pós-operatório. MATERIAL E MÉTODOS: O projeto foi desenvolvido em duas etapas, sendo a primeira a estruturação da Jornada Digital, com a criação de plataforma com algoritmo para identificação de sintomas e direcionamento de condutas e a segunda a validação do programa em um estudo piloto. Foram incluídos no estudo pacientes a serem submetidos a cirurgias colorretais oncológicas, com idade entre 18 e 80 anos. O estudo foi conduzido nas dependências do A.C.Camargo Cancer Center. O monitoramento dos pacientes e o reporte de sinais e sintomas pelos pacientes foram realizados via plataforma de monitoramento remoto, utilizando-se de smartphone ou computador. RESULTADOS: No estudo piloto, em cada uma das três fases de avaliação dos dados obtidos, algoritmo e instrumento para coleta de dados foram reestruturados, visando atingir maior sensibilidade e especificidade na detecção de complicações pela plataforma, bem como maior satisfação dos pacientes em acompanhamento. A capacidade de detecção de complicações aumentou a cada fase de análise e ajuste, sendo que após a terceira e última fase de ajustes tivemos 45(71,4%) eventos adversos reportados, sendo que destes, 12(19%) foram sintomas classificados como graves. Nessa amostra , a solução digital foi capaz de identificar 3(4,8%) complicações reais com sensibilidade de 75%, especificidade de 84%, acurácia de 83%, valor preditivo positivo de 25% e valor preditivo negativo de 98%. Tivemos ainda , 5(7,9%) erros de preenchimentos detectados e 1(1,6%) complicações não detectadas pela plataforma, por erro de preenchimento do questionário de avaliação diária. A nossa taxa de reinternação por indicação da plataforma, nessa amostra foi de 2(3,2%) e de admissão na emergência, considerando encaminhamento ou não da plataforma foi de 8(12,7%). A adesão completa ao programa de monitoramento foi de 83%, com nota NPS variando de 69 a 95, sendo a maior nota obtida na última fase de avaliação. CONCLUSÃO: A plataforma digital criada mostrou-se segura, com altas taxas de adesão e boa aceitação pelos pacientes, mas ainda precisa ser ajustada com a intenção de reduzir custos de encaminhamento e admissão no setor de emergência.
INTRODUCTION: Colorectal surgeries are complex procedures, associated with higher rates of complications and readmissions than procedures at other surgical sites. Currently, standardized procedures aim the early recovery of patients treated for colorectal surgeries in order to reduce the length of hospital stay. The reduction in hospitalization time, however, despite being considered a positive result, may lead to a risk , since complications generally occur outside the hospital environment, making it difficult to assess and monitor these patients. OBJECTIVE: The aim of the present study was to develop a mobile health app , accessible on smartphones, to remotely monitor the signs and symptoms of patients in the postoperative period of colorectal surgeries, evaluating the outcomes of admission rate in the emergency department and rate of severe complications. (Clavien-Dindo 3 to 5) within a fifteen-day postoperative period. METHODS: The project was developed in two steps, the first being the structuring of the Digital Journey, with the creation of a platform with a decision algorithm for identifying symptoms and directing conducts, and the second the validation of the program in a pilot study. Patients aged between 18 and 80 years old, who were to undergo oncological colorectal surgeries, were included in the study. The study was conducted on the premises of the A.C.Camargo Cancer Center. Monitoring of patients and reporting of signs and symptoms by patients were performed via a remote monitoring platform, using a smartphone or computer. RESULTS: In the pilot study, in each of the three evaluation phases of the data obtained, the decision algorithm and the instrument for data collection were restructured, aiming to achieve greater sensitivity and specificity in the detection of complications by the platform, as well as greater patient satisfaction. The ability to detect complications increased at each analysis and adjustment phase, and after the third and final phase of adjustments, 45 (71.4%) adverse events were reported, of which 12 (19%) were symptoms classified as high grade. In this sample, the digital solution was able to identify 3 (4.8%) real complications with a sensitivity of 75%, specificity of 84%, accuracy of 83%, positive predictive value of 25% and negative predictive value of 98%. We also had, 5(7.9%) errors in filling out detected and 1(1.6%) complications not detected by the platform, due to error in filling out the daily assessment questionnaire. Our rehospitalization rate by indication of the platform, in this sample was 2 (3.2%) and admission to the emergency room, considering referral or not from the platform, was 8 (12.7%). Complete adherence to the monitoring program was 83%, with an NPS score ranging from 69 to 95, the highest score obtained in the last evaluation phase. CONCLUSION: The a mobile health app created was proved to be safe, with high adherence rates and good acceptance by patients, but it still needs to be adjusted with the intention of reducing costs of referral and admission to the emergency department
Assuntos
Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/complicações , Assistência ao Convalescente , Telemonitoramento , Inteligência ArtificialRESUMO
Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. Brazil does not have an official well established program for screening colorectal cancer. The aim of this study was to compare Guaiac Based Fecal Occult Blood Test (G-FOBT) to a kind of an Immunochemical Fecal Occult Blood Test (I-FOBT), in search of cancer or advanced adenoma. Methods: Prospective and cross-sectional study. Asymptomatic and average-risk individuals (n = 1500) aged from 50 to 75 years old were invited to participate in the study. The primary endpoint was positivity rate and the secondary endpoints were adherence rate and significant endoscopic findings. All participants received both tests with follow-up colonoscopy if either test was positive. Results: Adherence rate of G- FOBT was 756/1500 (50.4%) while for I- FOBT it was 960/1500(64%). The positivity ratio in the I- FOBT was 94/960 (9.8%) and in the G-FOBT was 20/771 (2.6%). The Positive Predict Value (PPV) for the I- FOBT counted 16/77 (21.0%) while for the G- FOBT it was 6/18 (33.0%), considering significant lesions. Regarding the colorectal cancer findings, the detection in the colonoscopy guided from the positivity of fecal occult blood tests was 5/77 (6.5%) in I- FOBT and 2/18 (11.1%) on the G- FOBT. Conclusions: The positivity, the adherence rate and the capacity to detect significant lesions were higher in I-FOBT. Considering the findings of the study we could conclude that I-FOBT was superior to G- FOBT. Trial registration: This study was reviewed and approved by the Institutional Review Board of A.C.Camargo Cancer Center, São Paulo, Brazil, number: 1877/14