Patient acceptability of CTC superior to BE for colorectal cancer diagnosis
MedWire News: Patients undergoing investigation of suspected colorectal cancer perceive computed tomographic colonography (CTC) as more acceptable and report fewer post-procedural side effects compared with patients undergoing barium enema (BE), UK study findings show.
The findings are of clinical importance, given that double contrast BE is the standard alternative to CTC for whole-colon investigation in symptomatic patients, and has been widely used for the past 40 years.
Steve Halligan (University College Hospital, London) and co-authors administered a questionnaire to patients aged 55 years or older with symptoms suggestive of colorectal cancer who had completed either BE (n=606) or CTC (n=315) to assess their experience of the procedure, including bowel preparation, procedure, and complications. Satisfaction, worry, and physical discomfort were assessed using an adapted version of a validated acceptability scale.
Study findings showed that more than two-thirds of patients reported the bowel preparation as the least acceptable part of the procedure (68.9% vs 74% for BE vs CTC, respectively). The test itself was rated as the least acceptable aspect of the procedure by 24.3% of patients who had BE compared with 13.7% of those who had CTC.
Overall, individuals undergoing BE were significantly less satisfied than those receiving CTC, with median Satisfaction sub-scale scores of 61 versus 64, respectively. Indeed, patients undergoing BE responded significantly less favourably than those receiving CTC on the individual items of 'dignity' and 'modesty'.
Physical discomfort was rated as significantly worse for patients receiving BE compared with CTC (median Physical Discomfort sub-scale scores of 40 vs 35.5, respectively). Significant differences were found for nine individual items on this scale, including 'pain', 'discomfort', 'bad experience', 'soreness', 'afraid of making a fool of myself', 'bloated afterwards', 'intrusiveness', 'hard to cope with', and 'hard to do what was required'.
No significant differences were seen between BE and CTC on any of the items on the Worry sub-scale.
Following the procedure, BE patients were significantly more likely to experience 'abdominal pain/cramps' (68% vs 57%), 'soreness' (57% vs 37%), 'nausea/vomiting' (16% vs 8%), 'soiling' (31% vs 23%), and 'wind' (92% vs 84%). The severity of post-procedural 'wind' was greatest for BE, with 27% of patients reporting it as 'severe' compared with 15% of patients undergoing CTC.
"The fact that CTC is more acceptable than BE while also offering superior diagnostic sensitivity indicates that it should replace BE as the standard radiological whole-colon investigation," conclude the authors in the journal European Radiology.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Ingrid Grasmo