Could an app help save you from colon cancer? Possibly. A researcher at Dell Medical School at the University of Texas at Austin has developed an app that can help explain to you the benefits of each type of colon cancer screening (there are many) and even help you schedule one.
Dr. Michael Pignone, chairman of the department of internal medicine at Dell Medical School, c0-authored a study that was published in the Annals of Internal Medicine.
The study followed 450 people who were overdue for a colon cancer screening. It either gave them an iPad with an app that walked them through the various screenings and preventative measures or it gave them a traditional patient education method, a short video on prevention methods, that did not include a way to schedule a screening. Both sets of patients then met with their doctors.
The patients who were given the app were twice as likely to schedule a follow-up screening as the ones who did not receive the app. What Pignone had learned from past work is that doctors don’t always offer all the screening options to their patients. “That limits the screening rates,” Pignone says. People ages 50 to 75 should receive a screening. If they have certain risk factors such as a family history or inflammatory bowel disease, they might need a screening even younger.
The app did have some safeguards. If a patient viewed the app and asked for a test, the doctor would then have to order it, giving the doctor the ability to make sure that method was appropriate for that patient. Stool testing, for example, isn’t for people at high risk, but by offering that option, Pignone says, it may reach some people who are refusing to do a colonoscopy.
The app walks patients through the different screening methods and how often they should be done:
- Fecal immunochemical test (every year)
- Stool DNA test (every 3 years)
- Colonoscopy (every 10 years)
- CT colonography (every 5 years)
- Flexible sigmoidoscopy (every 5 years)
- Double-contrast barium enema (every 5 years)
Pignone also tested when the best timing for delivering the app was. Patients responded best when they received it at their doctor’s office before their appointment. It’s like they are thinking, “I’m attending to my health today,” Pignone says.
The amount of patients in the study who went on to get testing was 30 percent with the app versus 15 percent with the traditional information. “Of course, we would like that to be higher, like 75 percent,” Pignone says.
Colorectal cancers are the third most common diagnosed cancer in the United States (excluding skin cancer) and the third most common cause of cancer deaths, according to the American Cancer Society. More than 50,000 people in the United States die from it.
The risk factors include:
- Being overweight
- Diets high in red meats or processed meats
- Alcohol use that is more than two drinks a day for men and one drink a day for women
- Being older than 50
- A history or family history of polyps or colon cancer
- Having inflammatory bowel disease
- Certain inherited diseases such as Lynch disease
- Being African-American
- Having Type 2 diabetes
The study points to more possibilities of how doctors can educate patients about their risk factors. Gone are the days of wheeling around a TV and VCR on a cart to provide education. Pignone envisions patients being able to download apps on their phones to get information, being sent links to apps or videos to watch on their phones through the patient portals their doctor’s office uses, receiving text reminders with links to education and more.
“Doctors have to get used to and people have to get used to giving more control to patients to engage them more,” Pignone says.
He would love for patients to receive all the information and links to sign up for tests before a doctor’s visit. Then the doctor could go over the results with the patients and schedule follow-up tests in a meaningful way at the time of the visit, rather than visit, then take tests, then receive your results in the mail, by phone call or by the patient portal.
While the app study happened while Pignone was working in North Carolina, Pignone is continuing to do work on colon cancer now that he is in Austin. He recently received a grant through the Cancer Prevention Research Institute of Texas to get more screening done in underserved populations of Austin. He is working with CommUnityCare to get their clients screened.
Of their 20,000 patients in the target age range, 13,000 were behind in their screenings. Those patients are now being mailed a stool test to do at home. If the test is negative, the patient gets a letter stating that. If it is positive, the patient gets a call from a bilingual care coordinator who helps schedule a follow-up test.
The grant is for three years.
“The hope is that we will demonstrate its effectiveness and cost effectiveness and find a way of continuing the program with local funding,” Pignone says.