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P198 Colorectal cancer diagnosis in patients with inflammatory bowel disease in Spain: A room for improvement

R. Saldana1, C. Savini1, P. Bella Castillo2, I. Vera Mendoza2, P. Nos Mateu3

1Patient Association, ACCU España, Madrid, Spain, 2Hospital Universitario Puerta de Hierro-Majadahonda, Inflammatory Bowel Disease Unit, Madrid, Spain, 3Hospital Universitario y Politécnico La Fe, Inflammatory Bowel Disease Unit, Valencia, Spain

Background

Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBD), characterised by chronic inflammation of the digestive tract. IBD patients have an increased risk of developing colorectal cancer (CRC) compared with the general population. A proper screening in this population is essential to guarantee an early CRC diagnosis and maximise the success of the treatment. The aim of the study was to analyse the usual clinical practice in the diagnosis of CRC in IBD patients in Spain, and possible areas of improvement.

Methods

This preliminary qualitative study was carried out through the creation of four round tables with gastroenterologists and oncologists from different cities of Spain. The opening and closing tables were composed by 1 representative of the Confederation of Associations of Patients with CD and UC of Spain, an expert patient, a nurse from an IBD Unit, a representative of the Spanish Working Group on CD and UC, a gastroenterologist, an oncologist. The first one was necessary to point out the issues that were considered as the most important ones to be discussed in the round tables. In the closing table, all the debates were analysed in order to formulate conclusions.

Results

According to health professionals, the average delay time from the suspicion of an IBD flare, until the diagnosis of a CRC, is 3 months. The difficulty and delay in the diagnosis of CRC is generally attributed to the fact that the symptoms of the two pathologies usually overlap. Medical specialists currently suggest performing chromoendoscopy, in order to increase the rate of early detection of CRC. However, even if patients’ management and CRC prevention are described by the ECCO guidelines, we identify a lack of standardisation of the techniques for the diagnosis of CRC, which cannot guarantee an equal follow-up of IBD patients at the national level. Also, it can vary not only depending on the geographical area, but also in the centre. The reasons why the follow-up cannot be done – or is not done properly, are the lack of time, human resources, diagnostic tools and patient collaboration.

Conclusion

From a quantitative point of view, specialists perceive the early CRC underdiagnosis in IBD patients as a minor problem, since they agree that there may be little escaping to the screenings that are routinely performed to these patients. On the other hand, at a qualitative level they recognise it is a major problem, since a delay in diagnosis or misdiagnosis can lead to patient’s death. Thus, hospital administrations should provide resources that allow an adequate follow-up of all IBD patients. Also, the creation of multidisciplinary units would guarantee better management of these patients.