Colorectal cancer is the third leading cause of cancer-related deaths for both men and women in the United States, according to the American Cancer Society. Screening can save lives, but the rate of screening for colorectal cancer is low, less than 65 percent, which means thousands of people die unnecessarily every year. Peter H. Schwartz, MD, PhD, hopes to make an impact on that issue by using precision health, specifically by providing patients with information about their individual risk factors.
“Our goals are to help patients and their providers make better decisions about what screening test to take and to increase the amount of screening, which is too low,” said Schwartz, who co-leads the Behavioral Science and Ethics cluster of the IU Precision Health Initiative (PHI).
Schwartz says a patient’s risk of having an advanced colorectal neoplasm (ACN), which is a cancer or precancerous polyp, can determine which test would be best to take. A colonoscopy is more effective for people who are at high risk of having an ACN, while patients who are at low risk may only need a less invasive test. Schwartz says screening rates go up when patients evaluate all screening options, instead of just the more invasive colonoscopy.
The research team led by Schwartz uses characteristics including age, waist circumference and family history to determine an individual’s risk for having an ACN. With a new $2.7 million grant from Patient-Centered Outcomes Research Institute (PCORI), patients who take part in the study will get a personalized message through their electronic health record patient portal with a screening recommendation.
“The main objective of this application is to test whether providing patients and their providers with personalized messages about ACN risk results in higher screening uptake and higher decision quality,” said Schwartz. “Our study will identify the impact on how many patients get screened within six months and whether they make an informed choice.”
Schwartz and his team will start recruiting patients in late spring 2020. Some of the pilot work and preparation for this study was supported by PHI.
Schwartz is the Director of the IU Center for Bioethics and Associate Professor of Medicine at IU School of Medicine. He also directs the Bioethics and Subject Advocacy Program of the Indiana Clinical and Translational Sciences Institute. Schwartz is also a member of the IU Simon Cancer Center's Cancer Prevention and Control research program.
The Patient-Centered Outcomes Research Institute (PCORI) is an independent nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information they need to make better-informed healthcare decisions. PCORI is committed to continuously seeking input from a broad range of stakeholders to guide its work.