Optimising decision-making in the management of dysplasia in inflammatory bowel disease
File(s)
Author(s)
Kabir, Misha Seemeen
Type
Thesis
Abstract
The aims of this thesis have been to build on the existing literature on colitis-associated dysplasia by developing a better understanding of the associated cancer risk in patients with inflammatory bowel disease (IBD), the factors that influence their management decision-making and the tools needed to optimise confidence and satisfaction in the process.
A systematic review and meta-analysis suggest that dysplasia detected during surveillance in the more modern videoendoscopic era is associated with lower rates of incidental cancers found at colectomy than previously thought, and low rates of progression to more advanced neoplasia after complete endoscopic resection of visible dysplasia.
A multicentre retrospective review into the potential aetiology of post-colonoscopy colorectal cancer diagnoses in patients with IBD colitis has shown that the majority were explained by suboptimal quality endoscopic surveillance. However, some cases highlighted the limitations of surveillance, due to the aggressive nature of IBD cancers and patients declining recommended cancer-preventative colectomy. An in-depth mixed-methods study undertaken with patients with IBD revealed an overestimation in the efficacy of surveillance and high tolerance of cancer risk to avoid their quality of life being disrupted by stoma, pouch and surgical complications. Positive clinical team behaviours, including providing transparent and personalised risk information, were associated with greater decision confidence. A survey study of IBD clinicians found that they lacked a clear understanding of the cancer risk associated with dysplasia and their management practices did not always adhere to recent international clinical guidance. Therefore, to communicate more personalised risk to colitis patients with low-grade dysplasia, an advanced neoplasia risk prediction web-tool UC-CaRE (www.uc-care.uk) has been developed and externally validated.
Finally, the work from all prior chapters has been consolidated to help inform the development of international Delphi-derived consensus statements and clinician and patient decision aids, with the aim of standardising management practice and improve dysplasia management counselling for future patients.
A systematic review and meta-analysis suggest that dysplasia detected during surveillance in the more modern videoendoscopic era is associated with lower rates of incidental cancers found at colectomy than previously thought, and low rates of progression to more advanced neoplasia after complete endoscopic resection of visible dysplasia.
A multicentre retrospective review into the potential aetiology of post-colonoscopy colorectal cancer diagnoses in patients with IBD colitis has shown that the majority were explained by suboptimal quality endoscopic surveillance. However, some cases highlighted the limitations of surveillance, due to the aggressive nature of IBD cancers and patients declining recommended cancer-preventative colectomy. An in-depth mixed-methods study undertaken with patients with IBD revealed an overestimation in the efficacy of surveillance and high tolerance of cancer risk to avoid their quality of life being disrupted by stoma, pouch and surgical complications. Positive clinical team behaviours, including providing transparent and personalised risk information, were associated with greater decision confidence. A survey study of IBD clinicians found that they lacked a clear understanding of the cancer risk associated with dysplasia and their management practices did not always adhere to recent international clinical guidance. Therefore, to communicate more personalised risk to colitis patients with low-grade dysplasia, an advanced neoplasia risk prediction web-tool UC-CaRE (www.uc-care.uk) has been developed and externally validated.
Finally, the work from all prior chapters has been consolidated to help inform the development of international Delphi-derived consensus statements and clinician and patient decision aids, with the aim of standardising management practice and improve dysplasia management counselling for future patients.
Version
Open Access
Date Issued
2022-12
Date Awarded
2023-10
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Wilson, Ana
Thomas-Gibson, Siwan
Hart, Ailsa
Sponsor
Guts UK
Grant Number
FSpR2018-06
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)