Analysis Of Colorectal Cancer Screening Results In Four Pilot Units And Practice Of Integrated Traditional Chinese And Western Medicine Prevention Model

This project was supported by the Beijing Traditional Chinese Medicine Science and Technology Development fund project "Research on the Mode of Secondary Prevention of Colorectal cancer with Equal Emphasis on Traditional Chinese and Western medicine in Rural Beijing based on three-level Linkage"(JCZX-2020-13).This study is divided into two parts:literature review and clinical study.Review:Research progress on colorectal cancer screening methods and colonoscopy compliance;Research progress on primary and secondary prevention and TCM prevention and treatment of colorectal cancer.The clinical study was divided into two parts:colorectal cancer screening results and colonoscopy compliance analysis of influencing factors;Practice of integrated Traditional Chinese and Western medicine prevention model for colorectal cancer in rural Areas of Beijing.Clinical researchPart I:Analysis of influencing factors of colorectal cancer screening results and colonoscopy complianceObjectiveOn the basis of questionnaire screening,the screening method of "human SDC2 gene methylation test" was introduced to conduct colorectal cancer screening practice for the study subjects,and the influence of different screening methods on colonoscopy compliance was explored to further improve the screening mode.To explore the influencing factors of colonoscopy compliance in high-risk population,in order to provide reference for promoting colorectal cancer screening and improving colonoscopy compliance in high-risk population of colorectal cancer.MethodsCombining the questionnaire survey of colorectal cancer High-risk Population screening questionnaire with human SDC2 gene methylation detection,Colorectal cancer screening was performed on 8135 permanent residents of Xishaoqu Village,Dongshaoqu Town,Miyun District,Beijing,about 2880 permanent residents of Zhaogou Village,Laiji Town,Xinmi City,Henan Province,1600 employees of Xiyuan Hospital,China Academy of Chinese Medical Sciences,and 1800 employees of the Third People’s Hospital of Zhengzhou City,Henan Province.According to the"Colorectal cancer high-risk Population Screening questionnaire" screening high-risk population,low-risk population,healthy population;Combined with the positive,gray area and negative results of "human SDC2 gene methylation test",high-risk population,low-risk population and normal population were identified together.Further colonoscopy was recommended for high-risk patients and the colonoscopy compliance rate was observed.Statistical analysis was conducted on the screening results of 4 pilot units to understand the number and proportion of high-risk population in each pilot unit,including the proportion of high-risk population in the questionnaire and the proportion of "human SDC2 gene methylation test" positive and gray area.To explore the effect of different screening methods on colonoscopy compliance and colonoscopy results.Colorectal cancer awareness Questionnaire and colonoscopy willingness Questionnaire were conducted on 3,455 permanent residents of Xishaoqu Village and 1,600 employees of Xiyuan Hospital.The awareness level and willingness to undergo colonoscopy under different risk factors were analyzed,and the reasons for reluctance to undergo colonoscopy were statistically analyzed.Gender,age,risk factors of colorectal cancer,awareness and colonoscopy willingness of high-risk population were analyzed to explore the influencing factors of colonoscopy compliance in high-risk population.SPSS28.0 was used for data analysis.The awareness level of colorectal cancer was descriptive analysis.χ2 test was used for univariate analysis and binary logistic regression was used for multivariate analysis.P<0.05 was considered as statistically significant difference.Results1.Colorectal cancer screening results1.1 Colorectal cancer screening results in four pilot unitsIn Beijing miyun area east west Shao Qu Shao Qu town village,China academy of traditional Chinese medicine xiyuan hospital,third people’s hospital of zhengzhou city,henan province,and henan xinmi town zhao ditch village in colorectal cancer screening,early finish of individuals at risk for colorectal cancer screening questionnaire survey and the "human SDC2 gene methylation detection" at the beginning of the screen,including 1855 people in the west Shao Qu village to participate in,There were 728 participants from Xiyuan Hospital,608 from The Third People’s Hospital of Zhengzhou and 1108 from Zhaogou Village,with a total participation rate of 52.85%(4299/8135).The risk rate of questionnaire was 9.79%(421/4299).Among 4299 people who participated in the questionnaire screening,2494 people participated in "human SDC2 gene methylation detection",with a total participation rate of 58.01%(2494/4299).The total positive rate of SDC2 gene methylation was 7.30%(182/2494),and the total gray area rate of SDC2 gene methylation was 5.45%(136/2494).The total proportion of high-risk population based on the two screening methods was 15.38%(661/4299).1.2 Comparison of colonoscopy compliance between rural areas and hospitals in BeijingThe overall colonoscopy compliance rate of high-risk groups in Xishaoqu Village and Xiyuan Hospital was 19.47%(73/375),that of high-risk groups in Xishaoqu Village was 27.03%(50/185),and that of high-risk groups in Xiyuan Hospital was 12.11%(23/190).There was a difference between rural areas and hospitals(P<0.05).The colonoscopy compliance rate of high-risk groups in Xishaoqu Village was 15.00%(18/120),and that of high-risk groups in Xiyuan Hospital was 6.71%(10/149).The colonoscopy compliance rate of high-risk groups in rural questionnaire was higher than that of hospitals,and the difference was statistically significant(P<0.05).The colonoscopy compliance rate of people with positive "human SDC2 gene methylation test"/gray area in Xishaoqu Village was 39.73%(29/73),and that of people with positive "human SDC2 gene methylation test"/gray area in Xiyuan Hospital was 23%(23/71).1.2.1 Colonoscopy compliance under different screening methods in Xishaoqu VillageThe overall colonoscopy participation rate was 7.67%(22/287)with high-risk and low-risk questionnaire screening results.In the positive/gray area of SDC2 stool gene test,30 of the 71 patients underwent colonoscopy,and the participation rate of colonoscopy was 42.25%,which was higher than that of questionnaire screening.1.2.2 Colonoscopy compliance under different screening methods in Xiyuan HospitalThe overall colonoscopy participation rate was 6.19%(18/291)for high-risk and low-risk patients screened by questionnaire.In the positive/gray scale area of SDC2 stool gene test,23 of the 66 people received colonoscopy,and the participation rate of colonoscopy was 34.85%,which was higher than that of questionnaire screening.1.3 Analysis of colonoscopy results in rural areas and hospitals in BeijingAmong 375 high-risk groups,73 people underwent colonoscopy,and the colonoscopy compliance rate was 19.47%.Among the 73 colonoscopy results,19 cases(26.03%)were normal and 54 cases(73.97%)were abnormal,and the overall detection rate of abnormal colonoscopy results was 73.97%.In Xishaoqu village,there were 16 cases(32.00%)with normal colonoscopy,and 34 cases(68.00%)with abnormal colonoscopy.The detection rate of abnormal colonoscopy was 68.00%.In Xiyuan Hospital,3 cases(13.04%)were normal and 20 cases(86.96%)were abnormal.The detection rate of abnormal colonoscopy in Xiyuan Hospital was 86.96%.1.3.1 Colonoscopy results under different screening methods in Xishaoqu VillageThere were 22 people who received colonoscopy among the people with low risk according to the questionnaire examination results,among which 12 people had abnormal colonoscopy results,accounting for 54.55%.Among the people with normal results,28 people received colonoscopy,among which 22 people had abnormal results,accounting for 78.57%.There were 30 people who received colonoscopy in the positive/gray area of SDC2 stool gene test,and 23 of them had abnormal colonoscopy results,the abnormal proportion was 76.67%.In the SDC2 stool gene test negative population,3 people underwent colonoscopy,colonoscopy results were normal,abnormal proportion was 0.Compared with questionnaire survey,SDC2 fecal gene detection has higher accuracy.1.3.2 Colonoscopy results under different screening methods in Xiyuan HospitalThere were 18 people who received colonoscopy among the people with low risk according to the questionnaire examination results,among which 13 people had abnormal colonoscopy results,accounting for 72.22%.In the group with normal questionnaire results,5 people received colonoscopy,and the colonoscopy results were all abnormal,the abnormal proportion was 100.00%.There were 23 people who received colonoscopy in the positive/gray area of SDC2 stool gene test,and 18 of them had abnormal colonoscopy results,accounting for 78.26%.Colonoscopy was performed on all patients with positive/gray scale SDC2 stool gene test,and no one with negative test result underwent colonoscopy.Compared with questionnaire survey,SDC2 fecal gene detection has higher accuracy.2.Analysis of influencing factors of colonoscopy compliance2.1 Analysis of colonoscopy willingness questionnaire results in rural areas of BeijingA total of 551 people in rural areas participated in the questionnaire survey on colonoscopy willingness.The results showed that different risk factors had an impact on the choice of colonoscopy willingness,and the risk factors of "fecal gene test positive/gray area" had the highest willingness to colonoscopy,with statistical significance(P<0.05).The reasons for not wanting to do colonoscopy are(1)too expensive;(2)Long queue for colonoscopy;(3)fear of colonoscopy;(4)clearing the intestine is too painful;(5)I am too busy to have time.(6)No symptoms need no screening.The biggest reasons for not wanting to undergo a colonoscopy were fear of colonoscopy(29.17 percent)and no need for screening if there are no symptoms(29.86 percent).2.2 Single-factor analysis of colonoscopy compliance among rural and hospital colorectal cancer high-risk population in BeijingA total of 375 high-risk patients were screened in rural areas and hospitals in Beijing,and 73 patients underwent colonoscopy,with a compliance rate of 19.47%.Univariate analysis showed that colonoscopy compliance of colorectal cancer high-risk group was related to colorectal cancer awareness,colonoscopy willingness,fecal gene test results,questionnaire risk level,education level,residence and fecal occult blood positive(P<0.05).2.3 Multivariate Logistic regression analysis of overall colonoscopy compliance among rural and hospital-based colorectal cancer high-risk population in Beijing Multivariate logistic regression analysis showed that colonoscopy compliance of colorectal cancer high-risk population was related to colorectal cancer awareness and fecal gene test results(P<0.05).The proportion of people with a passing level of colorectal cancer awareness participating in colonoscopy screening was significantly higher than that of people with a failing level of colorectal cancer awareness(OR=3.29).The proportion of people with positive fecal gene test OR gray area participating in colonoscopy screening was higher than that of people with negative fecal gene test(OR=1.807).ConclusionBased on the screening results,the questionnaire screening method is easy to miss the abnormal population,so it is necessary to further standardize and improve the topic of the questionnaire.Early screening of colorectal cancer can detect abnormal results of colonoscopy in advance,and SDC2 gene methylation test,as a new noninvasive screening tool,can improve colonoscopy compliance.According to the improvement of screening methods for reasons of reluctance to undergo colonoscopy,colonoscopy compliance of colorectal cancer high-risk population is related to colorectal cancer awareness,colonoscopy willingness,fecal genetic test results,questionnaire risk level,education level,place of residence,and fecal occult blood positive.Colorectal cancer awareness and colonoscopy willingness are non-objective factors that can be changed.Improving residents’ knowledge of colorectal cancer screening is an effective means to improve colonoscopy compliance.Part II:Practice of integrated Traditional Chinese and Western medicine prevention model for colorectal cancer in rural Areas of BeijingObjectiveBased on the prevention model of integrated Traditional Chinese and Western medicine for colorectal cancer in rural Areas of Beijing under the three-level linkage,the change of awareness level after health education was explored.To understand the acceptance of rural residents to health education and different TCM intervention methods,so as to further improve the prevention model.MethodsUnder the "three-level linkage"(first-level hospital-second-level hospitalthird-level hospital),through the "TCM tumor screening" mini-program as a communication bridge,the residents of Xishaoqu Village,the backbone of the village,the town health center,the district Hospital of Traditional Chinese Medicine and Xiyuan Hospital of China Academy of Chinese Medical Sciences are connected.Improve the follow-up process of small program for different risk groups,and increase the function of SMS reminder,so as to provide better health guidance and form an effective working closed loop.Using the method of questionnaire survey,the residents of Xishaoqu village awareness questionnaire survey,the acceptance of health education approach questionnaire survey and high-risk groups of different traditional Chinese medicine intervention questionnaire survey.To explore the effect of health education by comparing the score changes of awareness before and after education.Questionnaire survey on different propaganda and education approaches and TCM intervention methods can optimize the current propaganda and education approaches and intervention methods according to the preference degree of different approaches among rural people,and further improve the prevention mode of colorectal cancer with integrated Traditional Chinese and Western medicine.1.Questionnaire survey of health awareness of Residents in Xishaoqu Village before and after health educationHealth education was conducted for residents in Xishaoqu Village.After each health education,questionnaires were filled in to analyze the difference of awareness level before and after health education.2.Questionnaire survey of residents’ acceptance of health education in Xishaoqu VillageIn order to understand the acceptance of different health education methods,a questionnaire survey was conducted on the residents of Xishaoqu village.3.Questionnaire survey on the acceptance of different TCM intervention methods among high-risk population in Xishaoqu VillageA questionnaire survey was conducted on TCM intervention methods among high-risk population in Xishaoqu Village,including drug intervention and non-drug intervention methods,to understand the acceptance of different intervention methods among high-risk population.Results1.The score of residents’ awareness of health education in Xishaoqu VillageThe scores of 1074 participants in the awareness questionnaire showed that the proportion of respondents in the multiple mission group with the awareness score of 90 or above was higher than that in the single mission group,P<0.05,and the difference was statistically significant.The results showed that the mean and median scores of the multiple mission group were higher than those of the single mission group.Since the data did not follow normal distribution,Wilcoxon rank-sum test was used to test the hypothesis,and the result showed that the statistic W=306576,P<0.05,the difference was statistically significant.2.Survey results of acceptance of different TCM intervention methods among high-risk population in Xishaoqu VillageA total of 185 high-risk people in Xishaoqu village participated in the questionnaire survey of intervention methods.Perform a frequency analysis for each option."Exercise intervention" was the most frequently selected,accounting for 22.19%,followed by"dietary guidance",accounting for 20.69%,and the average proportion of non-drug intervention guidance was 20.25%."TCM decoction intervention" accounted for 15.40%,while "Chinese patent medicine intervention"accounted for 18.21%.The average proportion of drug intervention guidance was 16.81%.Non-drug intervention guidance was more acceptable than drug intervention guidance.The most popular type of non-drug intervention guidance is exercise guidance.3.The survey results of residents’ acceptance of health education in Xishaoqu VillageThere are mainly four ways of health propaganda and education:media,magazines and newspapers,propaganda column and doctor’s lecture.Among them,the most popular way of health education was "doctor’s propaganda lecture",which was accepted by 809 people,accounting for 70.78%of the total number of people,higher than other ways of health education.The acceptability of "media" and"propaganda column" was basically the same,19.77%and 19.25%,respectively.The acceptance rate of "magazine and newspaper" was the worst,only 12.42%.ConclusionsThe results show that health education and TCM intervention guidance can improve the awareness of colorectal cancer in the population,and have a certain effect in enhancing the health awareness of residents.Rural residents have a certain preference for health education,and adopting the health education method that is more acceptable to residents can achieve better results,while the combination of various health education methods can also cover more people with health knowledge.At the same time,exploring more health propaganda and education methods can broaden the existing publicity channels and improve the publicity and education methods,so as to better carry out the work of health knowledge popularization,and guide the TCM intervention programs for the different risk groups screened out,so as to better realize the primary and secondary prevention of colorectal cancer.