@Article{info:doi/10.2196/62756, author="Yau, Yui Sarah Tsz and Hung, Tim Chi and Leung, Man Eman Yee and Lee, Albert and Yeoh, Kiong Eng", title="Survival Tree Analysis of Interactions Among Factors Associated With Colorectal Cancer Risk in Patients With Type 2 Diabetes: Retrospective Cohort Study", journal="JMIR Public Health Surveill", year="2025", month="Apr", day="29", volume="11", pages="e62756", keywords="colorectal cancer", keywords="risk factor", keywords="interaction", keywords="type 2 diabetes", keywords="survival analysis", keywords="decision tree", keywords="recursive partitioning", keywords="segmentation", keywords="risk stratification", keywords="public health", abstract="Background: Colorectal cancer (CRC) and diabetes share many common lifestyle risk factors, such as obesity. However, it remains largely unknown how different factors interact to influence the risk of CRC development among patients with diabetes. Objective: This study aimed to identify the interaction patterns among factors associated with the risk of CRC incidence among patients with diabetes. Methods: This is a retrospective cohort study conducted using electronic health records from Hong Kong. Patients who were diagnosed with type 2 diabetes and received care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. A conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of CRC. Results: A total of 386,325 patients were included. During a median follow-up of 6.2 years (IQR 3.3-8.0), 4199 patients developed CRC. Patients were first partitioned into 4 age groups by increased levels of CRC risk (?54 vs 55 to 61 vs 62 to 73 vs >73 years). Among patients aged more than 54 years, male sex was the dominant risk factor for CRC within each age stratum and the associations lessened with age. Abdominal obesity (waist-to-hip ratio >0.95) and longer duration of diabetes (median 12, IQR 7-18 vs median 4, IQR 1-11 years) were identified as key risk factor for CRC among men aged between 62 and 73 years and women aged more than 73 years, respectively. Conclusions: This study suggests the interaction patterns among age, sex, waist-to-hip ratio, and duration of diabetes on the risk of CRC incidence among patients with diabetes. Findings of the study may help identify target groups for public health intervention strategies. ", doi="10.2196/62756", url="https://publichealth.jmir.org/2025/1/e62756" } @Article{info:doi/10.2196/64809, author="McElroy, A. Jane and Smith, B. Jamie and Everett, D. Kevin", title="Monthly Variations in Colorectal Cancer Screening Tests Among Federally Qualified Health Center Patients in Missouri: Quality Improvement Project", journal="JMIR Cancer", year="2025", month="Mar", day="19", volume="11", pages="e64809", keywords="colorectal cancer screening", keywords="federally qualified health center", keywords="FQHC", keywords="fecal immunochemical test", keywords="FIT", keywords="FIT-DNA", keywords="colorectal cancer", keywords="CRC", keywords="cancer", keywords="cancer screening", keywords="colonoscopy", keywords="United States", keywords="health center", keywords="quality improvement", abstract="Background: Cancer is the second leading cause of death in the United States. Compelling evidence shows screening detects colorectal cancer (CRC) at earlier stages and prevents the development of CRC through the removal of precancerous polyps. The Healthy People 2030 goal for CRC screening is 68.3\%, but only 36.5\% of Missouri federally qualified health center patients aged 50?75 years are up-to-date on CRC screening. For average risk patients, there are three commonly used screening tests in the United States---two types of stool tests collected at home (fecal immunochemical test [FIT]--immunochemical fecal occult blood test [FOBT] and FIT-DNA, such as Cologuard) and colonoscopies completed at procedural centers. Objective: This study aims to examine variation by month for the three types of CRC testing to evaluate consistent patient care by clinical staff. Methods: Data from 31 federally qualified health center clinics in Missouri from 2011 to 2023 were analyzed. A sample of 34,124 unique eligible ``average risk'' patients defined as persons not having a personal history of CRC or certain types of polyps, family history of CRC, personal history of inflammatory bowel disease, and personal history of receiving radiation to the abdomen or pelvic to treat a previous cancer or confirmed or suspected hereditary CRC syndrome. Another eligibility criterion is that patients need to be seen at least once at the clinic to be included in the denominator for the screening rate calculation. Descriptive statistics characterize the sample, while bivariate analyses assess differences in screening types by month. Results: Completion of CRC screening yielded statistically significant differences for patients completing the different types of CRC screening by month. October-January had the highest proportions of patients (644-680 per month, 8.5\%?10.2\%) receiving a colonoscopy, while February-April had the lowest (509-578 per month, 6.9\%?7.8\%), with 614 being the average monthly number of colonoscopies. For FIT-FOBT, June-August had the higher proportions of patients receiving this test (563-613 per month, 8.9\%?9.6\%), whereas December-February had the lowest (453-495 per month, 7.1\%?8\%), with 541 being the average monthly number of FIT-FOBT kits used. For FIT-DNA, March was the most popular month with 11.3\% (n=261 per month) of patients using the Cologuard test, followed by April, May, and November (207-220 per month, 8.7\%?9.4\%), and January and June (168-171 per month, 7.2\%-7.3\%) had the lowest proportion of patients using Cologuard, with 193 being the average monthly number of FIT-DNA kits used. Combining all tests, February had the fewest CRC tests completed (1153/16,173, 7.1\%). Conclusions: Home-based tests are becoming popular, replacing the gold standard colonoscopy, but need to be repeated more frequently. Monthly variation of screening over the course of a year suggests that CRC screening efforts and patient care may be less than ideal. Months with lower rates of screening for each type of CRC test represent opportunities for improving CRC screening. ", doi="10.2196/64809", url="https://cancer.jmir.org/2025/1/e64809" } @Article{info:doi/10.2196/53328, author="Zippi, D. Zachary and Cortopassi, O. Isabel and Grage, A. Rolf and Johnson, M. Elizabeth and McCann, R. Matthew and Mergo, J. Patricia and Sonavane, K. Sushil and Stowell, T. Justin and Little, P. Brent", title="Assessing Public Interest in Mammography, Computed Tomography Lung Cancer Screening, and Computed Tomography Colonography Screening Examinations Using Internet Search Data: Cross-Sectional Study", journal="JMIR Cancer", year="2025", month="Mar", day="11", volume="11", pages="e53328", keywords="lung cancer", keywords="lung cancer screening", keywords="breast cancer", keywords="mammography", keywords="colon cancer", keywords="CT colonography", keywords="Google search", keywords="internet", keywords="Google Trends", keywords="imaging-based", keywords="cancer screening", keywords="search data", keywords="noninvasive", keywords="cancer", keywords="CT", keywords="online", keywords="public awareness", keywords="big data", keywords="analytics", keywords="patient education", keywords="screening uptake", abstract="Background: The noninvasive imaging examinations of mammography (MG), low-dose computed tomography (CT) for lung cancer screening (LCS), and CT colonography (CTC) play important roles in screening for the most common cancer types. Internet search data can be used to gauge public interest in screening techniques, assess common screening-related questions and concerns, and formulate public awareness strategies. Objective: This study aims to compare historical Google search volumes for MG, LCS, and CTC and to determine the most common search topics. Methods: Google Trends data were used to quantify relative Google search frequencies for these imaging screening modalities over the last 2 decades. A commercial search engine tracking product (keywordtool.io) was used to assess the content of related Google queries over the year from May 1, 2022, to April 30, 2023, and 2 authors used an iterative process to agree upon a list of thematic categories for these queries. Queries with at least 10 monthly instances were independently assigned to the most appropriate category by the 2 authors, with disagreements resolved by consensus. Results: The mean 20-year relative search volume for MG was approximately 10-fold higher than for LCS and 25-fold higher than for CTC. Search volumes for LCS have trended upward since 2011. The most common topics of MG-related searches included nearby screening locations (60,850/253,810, 24\%) and inquiries about procedural discomfort (28,970/253,810, 11\%). Most common LCS-related searches included CT-specific inquiries (5380/11,150, 48\%) or general inquiries (1790/11,150, 16\%), use of artificial intelligence or deep learning (1210/11,150, 11\%), and eligibility criteria (1020/11,150, 9\%). For CTC, the most common searches were CT-specific inquiries (1800/5590, 32\%) or procedural details (1380/5590, 25\%). Conclusions: Over the past 2 decades, Google search volumes have been significantly higher for MG than for either LCS or CTC, although search volumes for LCS have trended upward since 2011. Knowledge of public interest and queries related to imaging-based screening techniques may help guide public awareness efforts. ", doi="10.2196/53328", url="https://cancer.jmir.org/2025/1/e53328" } @Article{info:doi/10.2196/63486, author="Lyhne, Dam Johanne and Smith, `Ben' Allan and Carstensen, Wisbech Tina Birgitte and Beatty, Lisa and Bamgboje-Ayodele, Adeola and Klein, Britt and Jensen, Henrik Lars and Frostholm, Lisbeth", title="Adapting a Self-Guided eHealth Intervention Into a Tailored Therapist-Guided eHealth Intervention for Survivors of Colorectal Cancer", journal="JMIR Cancer", year="2025", month="Mar", day="5", volume="11", pages="e63486", keywords="fear of cancer recurrence", keywords="therapist-guided", keywords="self-guided", keywords="online intervention", keywords="colorectal cancer", keywords="digital health", keywords="psychosocial intervention", keywords="survivorship", keywords="eHealth", keywords="adaptation", keywords="survivors", keywords="oncologists", keywords="therapists", keywords="acceptability", keywords="mobile phone", abstract="Trial Registration: ClinicalTrials.gov NCT04287218; https://clinicaltrials.gov/study/NCT04287218 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-020-06731-6 ", doi="10.2196/63486", url="https://cancer.jmir.org/2025/1/e63486" } @Article{info:doi/10.2196/67425, author="Talen, Dani{\"e}lle A. and Leenen, L. Jobbe P. and van der Sluis, Geert and Oldenhuis, E. Hilbrand K. and Klaase, M. Joost and Patijn, A. Gijsbert", title="Feasibility of a Comprehensive eCoach to Support Patients Undergoing Colorectal Surgery: Longitudinal Observational Study", journal="JMIR Perioper Med", year="2025", month="Feb", day="25", volume="8", pages="e67425", keywords="eCoach", keywords="telehealth", keywords="remote monitoring", keywords="home monitoring", keywords="virtual", keywords="eHealth", keywords="colorectal surgery", keywords="colorectal cancer", keywords="prehabilitation", keywords="ERAS", keywords="rehabilitation", keywords="care pathway", keywords="patient journey", keywords="feasibility", keywords="coaching", keywords="mobile phone", abstract="Background: The mainstay of colorectal cancer care is surgical resection, which carries a significant risk of complications. Efforts to improve outcomes have recently focused on intensive multimodal prehabilitation programs to better prepare patients for surgery, which make the perioperative process even more complex and demanding for patients. Digital applications (eCoaches) seem promising tools to guide patients during their care journey. We developed a comprehensive eCoach to support, guide, and monitor patients undergoing elective colorectal surgery through the perioperative phase of the care pathway. Objective: The primary aim of this study was to determine its feasibility, in terms of recruitment rate, retention rate, and compliance. Also, usability and patient experience were examined. Methods: A single-center cohort study was conducted from April to September 2023 in a tertiary teaching hospital in the Netherlands. All elective colorectal surgery patients were offered an eCoach that provided preoperative coaching of the prehabilitation protocol, guidance by giving timely information, and remote monitoring of postoperative recovery and complications. Recruitment and retention rate, as well as compliance for each part of the care pathway, were determined. Secondary, patient-reported usability measured by the Usefulness, Satisfaction, and Ease of Use questionnaire and patient experiences were reported. Results: The recruitment rate for the eCoach was 74\% (49/66). Main reasons for exclusion were digital illiteracy (n=10), not owning a smartphone (n=3), and the expected burden of use being too high (n=2). The retention rate was 80\% (37/46). Median preoperative compliance with required actions in the app was 92\% (IQR 87-95), and postoperative compliance was 100\% (IQR 100-100). Patient-reported usability was good and patient experiences were mostly positive, although several suggestions for improvement were reported. Conclusions: Our results demonstrate the feasibility of a comprehensive eCoach for guiding and monitoring patients undergoing colorectal surgery encompassing the entire perioperative pathway, including prehabilitation and postdischarge monitoring. Compliance was excellent for all phases of the care pathway and recruitment and retention rates were comparable with rates reported in the literature. The study findings provide valuable insights for the further development of the eCoach and highlight the potential of digital health applications in perioperative support. ", doi="10.2196/67425", url="https://periop.jmir.org/2025/1/e67425" } @Article{info:doi/10.2196/63344, author="Srivastava, Aditi and Stimpson, P. Jim", title="Instagram Posts Promoting Colorectal Cancer Awareness: Content Analysis of Themes and Engagement During Colorectal Cancer Awareness Month", journal="JMIR Form Res", year="2025", month="Feb", day="19", volume="9", pages="e63344", keywords="social media", keywords="colorectal neoplasms", keywords="early detection of cancer", keywords="public health", keywords="health inequities", keywords="harnessing", keywords="Instagram", keywords="colorectal cancer", keywords="colorectal cancer awareness", keywords="content analysis", keywords="cancer-related deaths", keywords="detection", keywords="screening", keywords="mortality", keywords="post", keywords="early detection", abstract="Background: Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide, with early detection and screening being critical for reducing mortality. Social media platforms like Instagram offer a unique opportunity to raise awareness about CRC, particularly during designated awareness months. However, there is limited research on the effectiveness of CRC-related content on Instagram. Objective: This study aims to examine how Instagram is used to raise awareness about CRC during Colorectal Cancer Awareness Month by analyzing the thematic content and engagement metrics of related posts. The research seeks to identify the prevalent themes, assess audience interaction with these messages, and highlight areas for improvement in leveraging Instagram as a tool for cancer awareness campaigns. Methods: A total of 150 Instagram posts were collected based on their use of specific hashtags related to CRC awareness (\#colorectalcancer, \#colorectalcancerawareness, \#colorectalcancerawarenessmonth) during March 2024. The text and images in the posts were categorized into themes such as screening and early detection, symptoms, general awareness, risk factors, individual's experiences, representation of racial and ethnic minoritized communities, and representation of women. Engagement metrics, including the number of likes and comments, were also analyzed. Two researchers independently coded the posts, achieving high interrater reliability (Cohen $\kappa$=0.93). Results: Organizational accounts were more active, contributing 82\% (n=123) of the 150 posts, compared to 18\% (n=27) from individual users. The most frequently mentioned theme was screening and early detection, which made up 37.3\% (n=56) of all posts. General awareness came in second at 19.3\% (n=29), and risk factors came in third at 12\% (n=18). Posts about individual experiences and general awareness received the highest engagement, indicating the effectiveness of personal narratives and broad informational content. Themes related to symptoms and representation of racial and ethnic minoritized communities and women were underrepresented. Conclusions: This study highlights the potential of Instagram as a platform for promoting CRC awareness, particularly through posts about screening and early detection and personal experiences. However, there is a need for more inclusive and diverse content to ensure a broader reach and impact. ", doi="10.2196/63344", url="https://formative.jmir.org/2025/1/e63344" } @Article{info:doi/10.2196/62835, author="Chen, Raphael Hui Lionel and Chong, Dawn Qingqing and Tay, Brenda and Zhou, Siqin and Wong, Ting Evelyn Yi and Seow-En, Isaac and Tan, Kan Ker and Wang, Yi and Seow, Adeline and Tan, Emile Kwong-Wei and Tan, Iain Bee Huat and Tan, Huey Sze", title="Trends in Early-Onset Colorectal Cancer in Singapore: Epidemiological Study of a Multiethnic Population", journal="JMIR Public Health Surveill", year="2025", month="Feb", day="14", volume="11", pages="e62835", keywords="early-onset colorectal cancer", keywords="epidemiology", keywords="Singapore", keywords="joinpoint regression", keywords="age-period-cohort", keywords="public health", keywords="health disparity", abstract="Background: Colorectal cancer (CRC) incidence and mortality in those aged 50 years and above have decreased over the past 2 decades. However, there is a rising incidence of CRC among individuals under 50 years of age, termed early-onset colorectal cancer (EOCRC). Patients with EOCRC are diagnosed at an advanced stage and may be in more psychosocial, emotional, and financial distress. Objective: Our study examined the epidemiological shifts in CRC in Singapore, a multiethnic country. Methods: CRCs diagnosed at age 20 years and above were identified from the Singapore Cancer Registry (SCR) from 1968 to 2019. Patient characteristics included gender, ethnicity, and age of CRC diagnosis. Population information was obtained from the Department of Statistics Singapore (SingStat). Age-specific incidence rates (ASRs) and age-standardized incidence rates (ASIRs) were calculated. The cohort was divided into 3 age groups: 20-49, 50-64, and ?65 years. Temporal trends in incidence rates were modeled with joinpoint regression. Birth cohort models were fitted using the National Cancer Institute (NCI) age-period-cohort analysis tool. Cancer-specific survival analysis was performed with the Cox proportional hazards model. Results: In total, 53,044 CRCs were included, and 6183 (11.7\%) adults aged 20-49 years were diagnosed with EOCRC. The ASR of EOCRC rose from 5 per 100,000 population in 1968 to 9 per 100,000 population in 1996 at 2.1\% annually and rose to 10 per 100,000 population in 2019 at 0.64\% annually. The ASR for CRC among adults aged 50-64 years rose at 3\% annually from 1968 to 1987 and plateaued from 1987, while the ASR for adults aged 65 years and above rose at 4.1\% annually from 1968 to 1989 and 1.3\% annually from 1989 to 2003 but decreased from 2003 onwards at 1\% annually. The ASR of early-onset rectal cancer increased significantly at 1.5\% annually. There was a continued rise in the ASR of EOCRC among males (annual percentage change [APC] 1.5\%) compared to females (APC 0.41\%). Compared to the 1950-1954 reference birth cohort, the 1970-1984 birth cohort had a significantly higher incidence rate ratio (IRR) of 1.17-1.36 for rectal cancer, while there was no significant change for colon cancer in later cohorts. There were differences in CRC trends across the 3 ethnic groups: Malays had a rapid and persistent rise in the ASR of CRC across all age groups (APC 1.4\%-3\%), while among young Chinese, only the ASR of rectal cancer was increasing (APC 1.5\%). Patients with EOCRC had better survival compared to patients diagnosed at 65 years and above (hazard ratio [HR] 0.73, 95\% CI 0.67-0.79, P<.001) after adjusting for covariates. Conclusions: The rise in the incidence of rectal cancer among young adults, especially among Chinese and Malays, in Singapore highlights the need for further research to diagnose CRC earlier and reduce cancer-related morbidity and mortality. ", doi="10.2196/62835", url="https://publichealth.jmir.org/2025/1/e62835" } @Article{info:doi/10.2196/67043, author="Jacob, Christine and M{\"u}ller, Roman and Sch{\"u}ler, Sonja and Rey, Alix and Rey, Guillaume and Armenian, Berj and Vonlaufen, Alain and Drepper, Michael and Zimmerli, Marius", title="Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="12", volume="12", pages="e67043", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="technology assessment", keywords="technology adoption", keywords="technology implementation", keywords="usability study", keywords="colonoscopy", keywords="app", keywords="application", keywords="examinations", keywords="smartphone", keywords="usability", abstract="Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25\% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app's usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants' task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app's usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100\% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. ", doi="10.2196/67043", url="https://humanfactors.jmir.org/2025/1/e67043" } @Article{info:doi/10.2196/64747, author="Kennedy, Fiona and Smith, Susan and Beeken, J. Rebecca and Buck, Caroline and Williams, Sarah and Martin, Charlene and Lally, Phillippa and Fisher, Abi", title="An App-Based Intervention With Behavioral Support to Promote Brisk Walking in People Diagnosed With Breast, Prostate, or Colorectal Cancer (APPROACH): Process Evaluation Study", journal="JMIR Cancer", year="2025", month="Feb", day="10", volume="11", pages="e64747", keywords="cancer", keywords="physical activity", keywords="process evaluation", keywords="randomized controlled trial", keywords="intervention", keywords="app", keywords="habit", abstract="Background: The APPROACH pilot study explored the feasibility and acceptability of an app (NHS Active 10) with brief, habit-based, behavioral support calls and print materials intended to increase brisk walking in people diagnosed with cancer. Objective: Following UK Medical Research Council guidelines, this study assessed the implementation of the intervention, examined the mechanisms of impact, and identified contextual factors influencing engagement. Methods: Adults (aged ?18 y) with breast, prostate, or colorectal cancer who reported not meeting the UK guidelines for moderate-to-vigorous physical activity (?150 min/wk) were recruited from a single hospital site in Yorkshire, United Kingdom. They were randomly assigned to the intervention or control (usual care) arm and assessed via quantitative surveys at baseline (time point 0 [T0]) and 3-month follow-up (time point 1 [T1]) and qualitative exit interviews (36/44, 82\%) at T1. The process evaluation included intervention participants only (n=44). Implementation was assessed using data from the T1 questionnaire exploring the use of the intervention components. The perceived usefulness of the app, leaflet, and behavioral support call was rated from 0 to 5. Behavioral support calls were recorded, and the fidelity of delivery of 25 planned behavior change techniques was rated from 0 to 5 using an adapted Dreyfus scale. Mechanisms of impact were identified by examining T0 and T1 scores on the Self-Reported Behavioural Automaticity Index and feedback on the leaflet, app, call, and planner in the T1 questionnaire and qualitative interviews. Contextual factors influencing engagement were identified through qualitative interviews. Results: The implementation of the intervention was successful: 98\% (43/44) of the participants received a behavioral support call, 78\% (32/41) reported reading the leaflet, 95\% (39/41) reported downloading the app, and 83\% (34/41) reported using the planners. The mean perceived usefulness of the app was 4.3 (SD 0.8) in participants still using the app at T1 (n=33). Participants rated the leaflet (mean 3.9, SD 0.6) and the behavioral support call (mean 4.1, SD 1) as useful. The intended behavior change techniques in the behavioral support calls were proficiently delivered (overall mean 4.2, SD 1.2). Mechanisms of impact included habit formation, behavioral monitoring, and support and reassurance from the intervention facilitator. Contextual factors impacting engagement included barriers, such as the impact of cancer and its treatment, and facilitators, such as social support. Conclusions: The APPROACH intervention was successfully implemented and shows promise for increasing brisk walking, potentially through promoting habit formation and enabling self-monitoring. Contextual factors will be important to consider when interpreting outcomes in the larger APPROACH randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-022-01028-w ", doi="10.2196/64747", url="https://cancer.jmir.org/2025/1/e64747" } @Article{info:doi/10.2196/63864, author="Tong, Chau and Margolin, Drew and Niederdeppe, Jeff and Chunara, Rumi and Liu, Jiawei and Jih-Vieira, Lea and King, J. Andy", title="Colorectal Cancer Racial Equity Post Volume, Content, and Exposure: Observational Study Using Twitter Data", journal="J Med Internet Res", year="2025", month="Feb", day="3", volume="27", pages="e63864", keywords="racial equity information", keywords="information exposure", keywords="health disparities", keywords="colorectal cancer", keywords="cancer communication", keywords="Twitter", keywords="X", abstract="Background: Racial inequity in health outcomes, particularly in colorectal cancer (CRC), remains one of the most pressing issues in cancer communication and public health. Social media platforms like Twitter (now X) provide opportunities to disseminate health equity information widely, yet little is known about the availability, content, and reach of racial health equity information related to CRC on these platforms. Addressing this gap is essential to leveraging social media for equitable health communication. Objective: This study aims to analyze the volume, content, and exposure of CRC racial health equity tweets from identified CRC equity disseminator accounts on Twitter. These accounts were defined as those actively sharing information related to racial equity in CRC outcomes. By examining the behavior and impact of these disseminators, this study provides insights into how health equity content is shared and received on social media. Methods: We identified accounts that posted CRC-related content on Twitter between 2019 and 2021. Accounts were classified as CRC equity disseminators (n=798) if they followed at least 2 CRC racial equity organization accounts. We analyzed the volume and content of racial equity--related CRC tweets (n=1134) from these accounts and categorized them by account type (experts vs nonexperts). Additionally, we evaluated exposure by analyzing follower reach (n=6,266,269) and the role of broker accounts---accounts serving as unique sources of CRC racial equity information to their followers. Results: Among 19,559 tweets posted by 798 CRC equity disseminators, only 5.8\% (n=1134) mentioned racially and ethnically minoritized groups. Most of these tweets (641/1134, 57\%) addressed disparities in outcomes, while fewer emphasized actionable content, such as symptoms (11/1134, 1\%) or screening procedures (159/1134, 14\%). Expert accounts (n=479; 716 tweets) were more likely to post CRC equity tweets compared with nonexpert accounts (n=319; 418 tweets). Broker accounts (n=500), or those with a substantial portion of followers relying on them for equity-related information, demonstrated the highest capacity for exposing followers to CRC equity content, thereby extending the reach of these critical messages to underserved communities. Conclusions: This study emphasizes the critical roles played by expert and broker accounts in disseminating CRC racial equity information on social media. Despite the limited volume of equity-focused content, broker accounts were crucial in reaching otherwise unexposed audiences. Public health practitioners should focus on encouraging equity disseminators to share more actionable information, such as symptoms and screening benefits, and implement measures to amplify the reach of such content on social media. Strengthening these efforts could help bridge disparities in cancer outcomes among racially minoritized groups. ", doi="10.2196/63864", url="https://www.jmir.org/2025/1/e63864" } @Article{info:doi/10.2196/56791, author="Mourato, Beatriz Maria and Pratas, Nuno and Branco Pereira, Andreia and Tar{\'e}, Filipa and Chan{\c{c}}a, Raphael and Fronteira, In{\^e}s and Dinis, Rui and Areia, Miguel", title="Effectiveness of Gastric Cancer Endoscopic Screening in Intermediate-Risk Countries: Protocol for a Systematic Review and Meta-Analysis", journal="JMIR Res Protoc", year="2025", month="Feb", day="3", volume="14", pages="e56791", keywords="gastric cancers", keywords="endoscopic screening", keywords="intermediate-risk countries", keywords="neoplasia", keywords="early detection", keywords="diagnosis", keywords="cancer screening", keywords="survival", keywords="meta-analysis", keywords="gastrointestinal cancers", abstract="Background: Gastric cancer (GC) is the fifth most prevalent neoplasm worldwide and the fourth with the highest mortality, and its geographical distribution is not homogeneous with high-risk, intermediate-risk (IR), and low-risk areas. Advanced stages at diagnosis are related to high mortality, but early detection greatly increases the chances of survival. Upper endoscopy with biopsy is the gold standard for GC diagnosis. Several studies have investigated the relevance of endoscopic screening and how to implemente it in IR countries. However, most Western societies recommend screening only in selected populations with high-risk factors for GC. No systematic reviews on GC endoscopic screening in IR countries exist. Objective: We aimed to determine the effectiveness of endoscopic GC screening in IR countries. Methods: We will include randomized and nonrandomized controlled trials, cohort studies, case-control studies, cross-sectional studies, and economic studies focusing on endoscopic screening of GC in the asymptomatic population of IR countries. The search will be conducted in MEDLINE, SCOPUS, Embase, and Web of Science. Other gray literature sources will be additionally searched. Studies published in English, Portuguese, or Spanish until September 2024 will be included. Two independent reviewers will screen the titles and abstracts of all search results. The selected studies will then be fully analyzed, and the data will be collected and coded in a database. To minimize the risk of bias, the included studies will undergo a quality analysis according to Cochrane risk of bias tools, RoB 2 of randomized trials and ROBINS-I for nonrandomized trials; Newcastle-Ottawa Quality Assessment Scale for case-control and cohort studies; and National Heart, Lung and Blood Institute study quality assessment tools for cross-sectional studies. The data collected will be cataloged in 2 categories: efficacy or effectiveness data and economic data, and separate meta-analyses will be performed for each category if appropriate. Results: This study is expected to provide results on the efficacy, effectiveness, and cost-effectiveness of endoscopic screening in an IR population. To date, 969 studies were screened for title and abstract, 75 were selected for full-text screening, and 44 were retained for data analysis. Additionally, 2 studies were selected from our manual search. Currently, the study is in the early stages of data extraction and risk of bias assessment and is expected to be published in the first quarter of 2025. Conclusions: To our knowledge, this review will be the first to provide evidence on the effectiveness of endoscopic GC screening in IR countries. In doing so, we believe we will help guide future research, inform health care decisions and assist policy makers in this area, and support future decisions to implement GC screening programs in this type of population. Trial Registration: PROSPERO CRD42024502174; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=502174 International Registered Report Identifier (IRRID): DERR1-10.2196/56791 ", doi="10.2196/56791", url="https://www.researchprotocols.org/2025/1/e56791", url="http://www.ncbi.nlm.nih.gov/pubmed/39545590" } @Article{info:doi/10.2196/58834, author="Voigt, Kelly and Sun, Yingtao and Patandin, Ayush and Hendriks, Johanna and Goossens, Hendrik Richard and Verhoef, Cornelis and Husson, Olga and Gr{\"u}nhagen, Dirk and Jung, Jiwon", title="A Machine Learning Approach Using Topic Modeling to Identify and Assess Experiences of Patients With Colorectal Cancer: Explorative Study", journal="JMIR Cancer", year="2025", month="Jan", day="27", volume="11", pages="e58834", keywords="colorectal cancer", keywords="forum", keywords="topic modeling", keywords="patient journey", keywords="patient experience", keywords="AI", keywords="machine learning", keywords="cancer care", keywords="cancer survivor", keywords="United States", keywords="quality of life", keywords="post", keywords="topic", keywords="artificial intelligence", abstract="Background: The rising number of cancer survivors and the shortage of health care professionals challenge the accessibility of cancer care. Health technologies are necessary for sustaining optimal patient journeys. To understand individuals' daily lives during their patient journey, qualitative studies are crucial. However, not all patients wish to share their stories with researchers. Objective: This study aims to identify and assess patient experiences on a large scale using a novel machine learning--supported approach, leveraging data from patient forums. Methods: Forum posts of patients with colorectal cancer (CRC) from the Cancer Survivors Network USA were used as the data source. Topic modeling, as a part of machine learning, was used to recognize the topic patterns in the posts. Researchers read the most relevant 50 posts on each topic, dividing them into ``home'' or ``hospital'' contexts. A patient community journey map, derived from patients stories, was developed to visually illustrate our findings. CRC medical doctors and a quality-of-life expert evaluated the identified topics of patient experience and the map. Results: Based on 212,107 posts, 37 topics and 10 upper clusters were produced. Dominant clusters included ``Daily activities while living with CRC'' (38,782, 18.3\%) and ``Understanding treatment including alternatives and adjuvant therapy'' (31,577, 14.9\%). Topics related to the home context had more emotional content compared with the hospital context. The patient community journey map was constructed based on these findings. Conclusions: Our study highlighted the diverse concerns and experiences of patients with CRC. The more emotional content in home context discussions underscores the personal impact of CRC beyond clinical settings. Based on our study, we found that a machine learning-supported approach is a promising solution to analyze patients' experiences. The innovative application of patient community journey mapping provides a unique perspective into the challenges in patients' daily lives, which is essential for delivering appropriate support at the right moment. ", doi="10.2196/58834", url="https://cancer.jmir.org/2025/1/e58834" } @Article{info:doi/10.2196/59464, author="Rivera Rivera, N. Jessica and Snir, Moran and Simmons, Emilie and Schmidlen, Tara and Sholeh, Misha and Maconi, Leigh Melinda and Geiss, Carley and Fulton, Hayden and Barton, Laura and Gonzalez, D. Brian and Permuth, Jennifer and Vadaparampil, Susan", title="Developing and Assessing a Scalable Digital Health Tool for Pretest Genetic Education in Patients With Early-Onset Colorectal Cancer: Mixed Methods Design", journal="JMIR Cancer", year="2025", month="Jan", day="17", volume="11", pages="e59464", keywords="genetic education", keywords="genetic testing", keywords="genetic counseling", keywords="digital health", keywords="early-onset colorectal cancer", abstract="Background: National guidelines recommend germline genetic testing (GT) for all patients with early-onset colorectal cancer. With recent advances in targeted therapies and GT, these guidelines are expected to expand to include broader groups of patients with colorectal cancer. However, there is a shortage of genetic professionals to provide the necessary education and support for informed consent. As such, there is a pressing need to identify alternative approaches to facilitate and expedite access to GT. Objective: This study describes the development of a pretest education intervention, Nest-CRC, to facilitate the uptake of germline GT among patients with early-onset colorectal cancer. Patients with early-onset colorectal cancer and health care providers reviewed Nest-CRC, and their reactions and recommendations were captured using a nested mixed methods approach. Methods: Using the learner verification approach, we conducted 2 sequential phases of surveys and interviews with English- and Spanish-speaking patients with early-onset colorectal cancer and health care providers. The surveys assessed participants' experiences with genetic services and provided immediate feedback on the Nest-CRC genetic education modules. Semistructured interviews evaluated participants' perceptions of self-efficacy, attraction, comprehension, cultural acceptability, and usability of Nest-CRC. Survey data were analyzed using descriptive statistics (mean, median, and proportions), while interview data were analyzed through line-by-line coding of the transcribed interviews. After each phase, Nest-CRC was refined based on participants' recommendations. Results: A total of 52 participants, including 39 patients with early-onset colorectal cancer and 13 providers, participated in the study. Of these, 19 patients and 6 providers participated in phase 1 (N=25), and 20 patients and 7 providers participated in phase 2 (N=27). Most participants (phase 1: 23/25, 92\%, to 25/25, 100\%; phase 2: 24/27, 89\%, to 27/27, 100\%) agreed that each of the 5 education modules was easy to understand and helpful; 13 patients reported no history of GT, with 11 (85\%) expressing interest in GT and 2 (15\%) remaining unsure after completing Nest-CRC. Participants reported that Nest-CRC provided sufficient information to help them decide about GT. The tool was deemed acceptable by individuals from diverse backgrounds, and participants found it visually attractive, easy to comprehend, and user-friendly. Conclusions: The findings revealed that Nest-CRC is a promising strategy for facilitating pretest education and promoting GT. Nest-CRC has been refined based on participant recommendations and will be re-evaluated. ", doi="10.2196/59464", url="https://cancer.jmir.org/2025/1/e59464" } @Article{info:doi/10.2196/53229, author="Ewing, P. Aldenise and Tounkara, Fode and Marshall, Daniel and Henry, V. Abhishek and Abdel-Rasoul, Mahmoud and McElwain, Skylar and Clark, Justice and Hefner, L. Jennifer and Zaire, J. Portia and Nolan, S. Timiya and Tarver, L. Willi and Doubeni, A. Chyke", title="Examining Racial Disparities in Colorectal Cancer Screening and the Role of Online Medical Record Use: Findings From a Cross-Sectional Study of a National Survey", journal="JMIR Cancer", year="2024", month="Dec", day="4", volume="10", pages="e53229", keywords="colorectal cancer", keywords="cancer screening", keywords="early detection", keywords="Health Information National Trends Survey", keywords="cancer disparities", keywords="online medical records", keywords="secondary data analysis", abstract="Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Early detection via routine CRC screening can significantly lower risks for CRC-specific morbidity and mortality. Public health initiatives between 2000 and 2015 nearly doubled CRC screening rates for some US adults. However, screening rates remain lowest for adults aged 45?49 years (20\%), patients of safety net health care facilities (42\%), adults without insurance (44\%), and other subgroups compared with national averages (72\%). Given the evolving landscape of digital health care and trends in web-based health information--seeking behaviors, leveraging online medical record (OMR) systems may be an underutilized resource to promote CRC screening utilization. Recognizing trends in OMR usage and patient demographics may enhance digital inclusion---a key social determinant of health---and support equitable web-based interventions aimed at boosting CRC screening across diverse populations. Objective: This study examined the association of accessing an OMR with CRC screening utilization and corresponding sociodemographic characteristics of US adults. Methods: In 2023, we conducted a secondary data analysis using a pooled, weighted sample from Health Information National Trends Survey (HINTS) 5 cycles, 2, 3, and 4 (2018?2020), a nationally representative survey assessing how US adults access and use health-related information. We analyzed the association between sociodemographic characteristics, medical conditions, OMR access, and CRC screening behaviors via logistic regression. Results: The sample included adults aged 45?75 years (N=5143). The mean age was 59 (SD 8) years for those who reported CRC screening and 52 (SD 6) years for those never screened. Nearly 70\% (4029/5143) of participants reported CRC screening and 52\% (2707/5143) reported OMR access in the past year. Adjusted odds of CRC screening were higher among non-Hispanic African American or Black adults than among non-Hispanic White adults (odds ratio [OR] 1.76, 95\% CI 1.22?2.53), adults who accessed an OMR (OR 1.89, 95\% CI 1.45?2.46), older individuals (OR 1.18, 95\% CI 1.16?1.21), the insured (OR 3.69, 95\% CI 2.34?5.82), and those with a professional or graduate degree versus those with a high school diploma or less (OR 2.65, 95\% CI 1.28?5.47). Individuals aged 65?75 years were significantly more likely (P<.001) to be screened (1687/1831, 91\%) than those aged 45?49 years (190/610, 29\%). Conclusions: Promoting OMR access, especially among the most disadvantaged Americans, may assist in reaching national screening goals. Emphasis should be placed on the mutability of OMR use compared with most other statistically significant associations with CRC screening behaviors. OMR access provides an intervenable means of promoting CRC education and screening, especially among those facing structural barriers to cancer diagnoses and care. Future research should focus on tailored and accessible interventions that expand OMR access, particularly for younger populations. ", doi="10.2196/53229", url="https://cancer.jmir.org/2024/1/e53229" } @Article{info:doi/10.2196/51655, author="Guan, Jia-Lun and Xia, Su-Hong and Zhao, Kai and Feng, Li-Na and Han, Ying-Ying and Li, Ji-Yan and Liao, Jia-Zhi and Li, Pei-Yuan", title="Videos in Short-Video Sharing Platforms as Sources of Information on Colorectal Polyps: Cross-Sectional Content Analysis Study", journal="J Med Internet Res", year="2024", month="Oct", day="29", volume="26", pages="e51655", keywords="colorectal polyps", keywords="short videos", keywords="health information", keywords="quality assessment", keywords="reliability", abstract="Background: Short videos have demonstrated huge potential in disseminating health information in recent years. However, to our knowledge, no study has examined information about colorectal polyps on short-video sharing platforms. Objective: This study aimed to analyze the content and quality of colorectal polyps-related videos on short-video sharing platforms. Methods: The terms ``???'' (intestinal polyps) or ``????'' (colonic polyps) or ``????'' (rectal polyps) or ``?????'' (colorectal polyps) or ``????'' (polyps of large intestine) were used to search in TikTok (ByteDance), WeChat (Tencent Holdings Limited), and Xiaohongshu (Xingyin Information Technology Limited) between May 26 and June 8, 2024, and then the top 100 videos for each search term on different platforms were included and recorded. The Journal of American Medical Association (JAMA) score, the Global Quality Scale (GQS), the modified DISCERN, and the Patient Education Materials Assessment Tool (PEMAT) were used to evaluate the content and quality of selected videos by 2 independent researchers. SPSS (version 22.0; IBM Corp) and GraphPad Prism (version 9.0; Dotmatics) were used for analyzing the data. Descriptive statistics were generated, and the differences between groups were compared. Spearman correlation analysis was used to evaluate the relationship between quantitative variables. Results: A total of 816 eligible videos were included for further analysis, which mainly conveyed disease-related knowledge (n=635, 77.8\%). Most videos were uploaded by physicians (n=709, 86.9\%). These videos had an average JAMA score of 2.0 (SD 0.6), GQS score of 2.5 (SD 0.8), modified DISCERN score of 2.5 (SD 0.8), understandability of 80.4\% (SD 15.6\%), and actionability of 42.2\% (SD 36.1\%). Videos uploaded by news agencies were of higher quality and received more likes and comments (all P<.05). The number of collections and shares of videos about posttreatment caveats were more than those for other content (P=.03 and P=.006). There was a positive correlation between the number of likes, comments, collections, and shares (all P<.001). The duration and the number of fans were positively correlated with the quality of videos (all P<.05). Conclusions: There are numerous videos about colorectal polyps on short-video sharing platforms, but the reliability and quality of these videos are not good enough and need to be improved. ", doi="10.2196/51655", url="https://www.jmir.org/2024/1/e51655", url="http://www.ncbi.nlm.nih.gov/pubmed/39470708" } @Article{info:doi/10.2196/50028, author="Thomson, D. Maria and Shahab, H. Guleer and Cooper-McGill, A. Chelsey and Sheppard, B. Vanessa and Hill, S. Sherrick and Preston, Michael and Keen II, Larry", title="Increasing Colorectal Cancer Screening Among Black Men in Virginia: Development of an mHealth Intervention", journal="JMIR Form Res", year="2024", month="Oct", day="10", volume="8", pages="e50028", keywords="colorectal cancer", keywords="cancer screening", keywords="mHealth", keywords="screening", keywords="Black men", keywords="early detection", keywords="health disparities", keywords="design thinking", abstract="Background: In the United States, colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other races or ethnicities, Black men have the lowest rates of CRC screening participation, which contributes to later-stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men. Objective: This study aims to report on the multistep process used to translate formative research including prior experiences implementing a national CRC education program, community advisory, and preliminary survey results into a culturally tailored mobile health (mHealth) intervention. Methods: A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking approach. Data to inform how content should be tailored were collected from the empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of 98 survey respondents. Results: A community advisory board identified changes for delivery that were private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation, and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local Federally Qualified Health Centers to connect participants directly to clinical care. Men surveyed (n=98) who live or work in the study area were an average of 59 (SD 7.9) years old and held high levels of mistrust of health care institutions. In the last 12 months, 25\% (24/98) of them did not see a doctor and 16.3\% (16/98) of them did not have a regular doctor. Regarding CRC, 27\% (26/98) and 38\% (37/98) of them had never had a colonoscopy or blood stool test, respectively. Conclusions: Working with a third-party developer, a prototype mHealth app that is downloadable, optimized for iPhone and Android users, and uses familiar sharing, video, and text messaging modalities was created. Guided by our results, we created 4 short videos (1:30-2 min) including a survivor vignette, animated videos about CRC and the type of screening tests, and a message from a community clinic partner. Men also receive tailored feedback and direct navigation to local Federally Qualified Health Center partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multipronged, theoretically informed approach to translate an existing but generalized CRC knowledge--based intervention into a digital, self-paced, tailored intervention with links to local community clinics. Trial Registration: ClinicalTrials.gov NCT05980182; https://clinicaltrials.gov/study/NCT05980182 ", doi="10.2196/50028", url="https://formative.jmir.org/2024/1/e50028" } @Article{info:doi/10.2196/53224, author="Savage, C. Leah and Soto-Cossio, Estefhany Luz and Minardi, Francesca and Beyrouty, Matthew and Schoonover, Julie and Musella, Jay and Frazier, Michaela and Villagra, N. Cristina and Sly, R. Jamilia and Erblich, Joel and Itzkowitz, H. Steven and Jandorf, H. Lina and Calman, S. Neil and Atreja, Ashish and Miller, J. Sarah", title="The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing", journal="JMIR Form Res", year="2024", month="Sep", day="25", volume="8", pages="e53224", keywords="digital navigation", keywords="digital health", keywords="Federally Qualified Health Center", keywords="colorectal cancer", keywords="cancer screening", keywords="mobile phone", abstract="Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a ``think aloud'' exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website's acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website's content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool's usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. ", doi="10.2196/53224", url="https://formative.jmir.org/2024/1/e53224" } @Article{info:doi/10.2196/50402, author="Cheng, Vienna and Sayre, C. Eric and Cheng, Vicki and Garg, Ria and Gill, Sharlene and Farooq, Ameer and De Vera, A. Mary", title="Patterns of Prescription Medication Use Before Diagnosis of Early Age-Onset Colorectal Cancer: Population-Based Descriptive Study", journal="JMIR Cancer", year="2024", month="Jul", day="12", volume="10", pages="e50402", keywords="colorectal cancer", keywords="medications", keywords="medication patterns", keywords="cancer diagnosis", keywords="prediagnosis", keywords="prescriptions", keywords="patterns", keywords="early-onset", keywords="population-based", keywords="incidence", keywords="male individuals", keywords="female individuals", keywords="health databases", keywords="pharmacology", keywords="diagnostic", keywords="descriptive study", keywords="gastroenterology", keywords="cancers", abstract="Background: Colorectal cancer (CRC) is estimated to be the fourth most common cancer diagnosis in Canada (except for nonmelanoma skin cancers) and the second and third leading cause of cancer-related death in male and female individuals, respectively. Objective: The rising incidence of early age-onset colorectal cancer (EAO-CRC; diagnosis at less than 50 years) calls for a better understanding of patients' pathway to diagnosis. Therefore, we evaluated patterns of prescription medication use before EAO-CRC diagnosis. Methods: We used linked administrative health databases in British Columbia (BC), Canada, to identify individuals diagnosed with EAO-CRC between January 1, 2010, and December 31, 2016 (hereinafter referred to as ``cases''), along with cancer-free controls (1:10), matched by age and sex. We identified all prescriptions dispensed from community pharmacies during the year prior to diagnosis and used the Anatomical Therapeutic Chemical Classification system Level 3 to group prescriptions according to the drug class. A parallel assessment was conducted for individuals diagnosed with average age-onset CRC (diagnosis at age 50 years and older). Results: We included 1001 EAO-CRC cases (n=450, 45\% female participants; mean 41.0, SD 6.1 years), and 12,989 prescriptions were filled in the year before diagnosis by 797 (79.7\%) individuals. Top-filled drugs were antidepressants (first; n=1698, 13.1\%). Drugs for peptic ulcer disease and gastroesophageal reflux disease (third; n=795, 6.1\%) were more likely filled by EAO-CRC cases than controls (odds ratio [OR] 1.4, 95\% CI 1.2-1.7) and with more frequent fills (OR 1.8, 95\% CI 1.7-1.9). We noted similar patterns for topical agents for hemorrhoids and anal fissures, which were more likely filled by EAO-CRC cases than controls (OR 7.4, 95\% CI 5.8-9.4) and with more frequent fills (OR 15.6, 95\% CI 13.1-18.6). Conclusions: We observed frequent prescription medication use in the year before diagnosis of EAO-CRC, including for drugs to treat commonly reported symptoms of EAO-CRC. ", doi="10.2196/50402", url="https://cancer.jmir.org/2024/1/e50402" } @Article{info:doi/10.2196/46625, author="Ow, Tsai-Wing and Sukocheva, Olga and Bampton, Peter and Iyngkaran, Guruparan and Rayner, K. Christopher and Tse, Edmund", title="Improving Concordance Between Clinicians With Australian Guidelines for Bowel Cancer Prevention Using a Digital Application: Randomized Controlled Crossover Study", journal="JMIR Cancer", year="2024", month="Feb", day="22", volume="10", pages="e46625", keywords="colorectal cancer", keywords="guidelines", keywords="colorectal cancer screening", keywords="digital application", keywords="questionnaire", keywords="application", keywords="cancer prevention", keywords="prevention", keywords="cancer", keywords="bowel cancer", keywords="surveillance", keywords="clinical vignette quiz", keywords="usability", keywords="Australia", abstract="Background: Australia's bowel cancer prevention guidelines, following a recent revision, are among the most complex in the world. Detailed decision tables outline screening or surveillance recommendations for 230 case scenarios alongside cessation recommendations for older patients. While these guidelines can help better allocate limited colonoscopy resources, their increasing complexity may limit their adoption and potential benefits. Therefore, tools to support clinicians in navigating these guidelines could be essential for national bowel cancer prevention efforts. Digital applications (DAs) represent a potentially inexpensive and scalable solution but are yet to be tested for this purpose. Objective: This study aims to assess whether a DA could increase clinician adherence to Australia's new colorectal cancer screening and surveillance guidelines and determine whether improved usability correlates with greater conformance to guidelines. Methods: As part of a randomized controlled crossover study, we created a clinical vignette quiz to evaluate the efficacy of a DA in comparison with the standard resource (SR) for making screening and surveillance decisions. Briefings were provided to study participants, which were tailored to their level of familiarity with the guidelines. We measured the adherence of clinicians according to their number of guideline-concordant responses to the scenarios in the quiz using either the DA or the SR. The maximum score was 18, with higher scores indicating improved adherence. We also tested the DA's usability using the System Usability Scale. Results: Of 117 participants, 80 were included in the final analysis. Using the SR, the adherence of participants was rated a median (IQR) score of 10 (7.75-13) out of 18. The participants' adherence improved by 40\% (relative risk 1.4, P<.001) when using the DA, reaching a median (IQR) score of 14 (12-17) out of 18. The DA was rated highly for usability with a median (IQR) score of 90 (72.5-95) and ranked in the 96th percentile of systems. There was a moderate correlation between the usability of the DA and better adherence (rs=0.4; P<.001). No differences between the adherence of specialists and nonspecialists were found, either with the SR (10 vs 9; P=.47) or with the DA (13 vs 15; P=.24). There was no significant association between participants who were less adherent with the DA (n=17) and their age (P=.06), experience with decision support tools (P=.51), or academic involvement with a university (P=.39). Conclusions: DAs can significantly improve the adoption of complex Australian bowel cancer prevention guidelines. As screening and surveillance guidelines become increasingly complex and personalized, these tools will be crucial to help clinicians accurately determine the most appropriate recommendations for their patients. Additional research to understand why some practitioners perform worse with DAs is required. Further improvements in application usability may optimize guideline concordance further. ", doi="10.2196/46625", url="https://cancer.jmir.org/2024/1/e46625", url="http://www.ncbi.nlm.nih.gov/pubmed/38238256" } @Article{info:doi/10.2196/50110, author="Ben-Aharon, Irit and Rotem, Ran and Melzer-Cohen, Cheli and Twig, Gilad and Cercek, Andrea and Half, Elizabeth and Goshen-Lago, Tal and Chodik, Gabriel and Kelsen, David", title="Pharmaceutical Agents as Potential Drivers in the Development of Early-Onset Colorectal Cancer: Case-Control Study", journal="JMIR Public Health Surveill", year="2023", month="Dec", day="13", volume="9", pages="e50110", keywords="early onset colorectal cancer", keywords="pharmaceutical agents", keywords="increased risk", keywords="colorectal cancer", keywords="health provider", keywords="Israel", keywords="machine learning", keywords="decision tree", keywords="gradient boosting", keywords="risk factors", keywords="decision support", keywords="risk", keywords="risks", keywords="colorectal", keywords="cancer", keywords="oncology", keywords="internal medicine", keywords="gastroenterology", keywords="gastrointestinal", keywords="pharmaceutical", keywords="pharmaceuticals", keywords="drug", keywords="drugs", abstract="Background: The incidence of early-onset colorectal cancer (EOCRC) rose abruptly in the mid 1990s, is continuing to increase, and has now been noted in many countries. By 2030, 25\% of American patients diagnosed with rectal cancer will be 49 years or younger. The large majority of EOCRC cases are not found in patients with germline cancer susceptibility mutations (eg, Lynch syndrome) or inflammatory bowel disease. Thus, environmental or lifestyle factors are suspected drivers. Obesity, sedentary lifestyle, diabetes mellitus, smoking, alcohol, or antibiotics affecting the gut microbiome have been proposed. However, these factors, which have been present since the 1950s, have not yet been conclusively linked to the abrupt increase in EOCRC. The sharp increase suggests the introduction of a new risk factor for young people. We hypothesized that the driver may be an off-target effect of a pharmaceutical agent (ie, one requiring regulatory approval before its use in the general population or an off-label use of a previously approved agent) in a genetically susceptible subgroup of young adults. If a pharmaceutical agent is an EOCRC driving factor, regulatory risk mitigation strategies could be used. Objective: We aimed to evaluate the possibility that pharmaceutical agents serve as risk factors for EOCRC. Methods: We conducted a case-control study. Data including demographics, comorbidities, and complete medication dispensing history were obtained from the electronic medical records database of Maccabi Healthcare Services, a state-mandated health provider covering 26\% of the Israeli population. The participants included 941 patients with EOCRC (?50 years of age) diagnosed during 2001-2019 who were density matched at a ratio of 1:10 with 9410 control patients. Patients with inflammatory bowel disease and those with a known inherited cancer susceptibility syndrome were excluded. An advanced machine learning algorithm based on gradient boosted decision trees coupled with Bayesian model optimization and repeated data sampling was used to sort through the very high-dimensional drug dispensing data to identify specific medication groups that were consistently linked with EOCRC while allowing for synergistic or antagonistic interactions between medications. Odds ratios for the identified medication classes were obtained from a conditional logistic regression model. Results: Out of more than 800 medication classes, we identified several classes that were consistently associated with EOCRC risk across independently trained models. Interactions between medication groups did not seem to substantially affect the risk. In our analysis, drug groups that were consistently positively associated with EOCRC included beta blockers and valerian (Valeriana officinalis). Antibiotics were not consistently associated with EOCRC risk. Conclusions: Our analysis suggests that the development of EOCRC may be correlated with prior use of specific medications. Additional analyses should be used to validate the results. The mechanism of action inducing EOCRC by candidate pharmaceutical agents will then need to be determined. ", doi="10.2196/50110", url="https://publichealth.jmir.org/2023/1/e50110", url="http://www.ncbi.nlm.nih.gov/pubmed/37933755" } @Article{info:doi/10.2196/44417, author="Yang, Xulin and Qiu, Hang and Wang, Liya and Wang, Xiaodong", title="Predicting Colorectal Cancer Survival Using Time-to-Event Machine Learning: Retrospective Cohort Study", journal="J Med Internet Res", year="2023", month="Oct", day="26", volume="25", pages="e44417", keywords="colorectal cancer", keywords="survival prediction", keywords="machine learning", keywords="time-to-event", keywords="SHAP", keywords="SHapley Additive exPlanations", abstract="Background: Machine learning (ML) methods have shown great potential in predicting colorectal cancer (CRC) survival. However, the ML models introduced thus far have mainly focused on binary outcomes and have not considered the time-to-event nature of this type of modeling. Objective: This study aims to evaluate the performance of ML approaches for modeling time-to-event survival data and develop transparent models for predicting CRC-specific survival. Methods: The data set used in this retrospective cohort study contains information on patients who were newly diagnosed with CRC between December 28, 2012, and December 27, 2019, at West China Hospital, Sichuan University. We assessed the performance of 6 representative ML models, including random survival forest (RSF), gradient boosting machine (GBM), DeepSurv, DeepHit, neural net-extended time-dependent Cox (or Cox-Time), and neural multitask logistic regression (N-MTLR) in predicting CRC-specific survival. Multiple imputation by chained equations method was applied to handle missing values in variables. Multivariable analysis and clinical experience were used to select significant features associated with CRC survival. Model performance was evaluated in stratified 5-fold cross-validation repeated 5 times by using the time-dependent concordance index, integrated Brier score, calibration curves, and decision curves. The SHapley Additive exPlanations method was applied to calculate feature importance. Results: A total of 2157 patients with CRC were included in this study. Among the 6 time-to-event ML models, the DeepHit model exhibited the best discriminative ability (time-dependent concordance index 0.789, 95\% CI 0.779-0.799) and the RSF model produced better-calibrated survival estimates (integrated Brier score 0.096, 95\% CI 0.094-0.099), but these are not statistically significant. Additionally, the RSF, GBM, DeepSurv, Cox-Time, and N-MTLR models have comparable predictive accuracy to the Cox Proportional Hazards model in terms of discrimination and calibration. The calibration curves showed that all the ML models exhibited good 5-year survival calibration. The decision curves for CRC-specific survival at 5 years showed that all the ML models, especially RSF, had higher net benefits than default strategies of treating all or no patients at a range of clinically reasonable risk thresholds. The SHapley Additive exPlanations method revealed that R0 resection, tumor-node-metastasis staging, and the number of positive lymph nodes were important factors for 5-year CRC-specific survival. Conclusions: This study showed the potential of applying time-to-event ML predictive algorithms to help predict CRC-specific survival. The RSF, GBM, Cox-Time, and N-MTLR algorithms could provide nonparametric alternatives to the Cox Proportional Hazards model in estimating the survival probability of patients with CRC. The transparent time-to-event ML models help clinicians to more accurately predict the survival rate for these patients and improve patient outcomes by enabling personalized treatment plans that are informed by explainable ML models. ", doi="10.2196/44417", url="https://www.jmir.org/2023/1/e44417", url="http://www.ncbi.nlm.nih.gov/pubmed/37883174" } @Article{info:doi/10.2196/41999, author="Qiu, Hang and Wang, Liya and Zhou, Li and Wang, Xiaodong", title="Comorbidity Patterns in Patients Newly Diagnosed With Colorectal Cancer: Network-Based Study", journal="JMIR Public Health Surveill", year="2023", month="Sep", day="5", volume="9", pages="e41999", keywords="colorectal cancer", keywords="comorbidity patterns", keywords="prevalence", keywords="health status disparities", keywords="network analysis", keywords="routinely collected health data", abstract="Background: Patients with colorectal cancer (CRC) often present with multiple comorbidities, and many of these can affect treatment and survival. However, previous comorbidity studies primarily focused on diseases in commonly used comorbidity indices. The comorbid status of CRC patients with respect to the entire spectrum of chronic diseases has not yet been investigated. Objective: This study aimed to systematically analyze all chronic diagnoses and diseases co-occurring, using a network-based approach and large-scale administrative health data, and provide a complete picture of the comorbidity pattern in patients newly diagnosed with CRC from southwest China. Methods: In this retrospective observational study, the hospital discharge records of 678 hospitals from 2015 to 2020 in Sichuan Province, China were used to identify new CRC cases in 2020 and their history of diseases. We examined all chronic diagnoses using ICD-10 (International Classification of Diseases, 10th Revision) codes at 3 digits and focused on chronic diseases with >1\% prevalence in at least one subgroup (1-sided test, P<.025), which resulted in a total of 66 chronic diseases. Phenotypic comorbidity networks were constructed across all CRC patients and different subgroups by sex, age (18-59, 60-69, 70-79, and ?80 years), area (urban and rural), and cancer site (colon and rectum), with comorbidity as a node and linkages representing significant correlations between multiple comorbidities. Results: A total of 29,610 new CRC cases occurred in Sichuan, China in 2020. The mean patient age at diagnosis was 65.6 (SD 12.9) years, and 75.5\% (22,369/29,610) had at least one comorbidity. The most prevalent comorbidities were hypertension (8581/29,610, 29.0\%; 95\% CI 28.5\%-29.5\%), hyperplasia of the prostate (3816/17,426, 21.9\%; 95\% CI 21.3\%-22.5\%), and chronic obstructive pulmonary disease (COPD; 4199/29,610, 14.2\%; 95\% CI 13.8\%-14.6\%). The prevalence of single comorbidities was different in each subgroup in most cases. Comorbidities were closely associated, with disorders of lipoprotein metabolism and hyperplasia of the prostate mediating correlations between other comorbidities. Males and females shared 58.3\% (141/242) of disease pairs, whereas male-female disparities occurred primarily in diseases coexisting with COPD, cerebrovascular diseases, atherosclerosis, heart failure, or renal failure among males and with osteoporosis or gonarthrosis among females. Urban patients generally had more comorbidities with higher prevalence and more complex disease coexistence relationships, whereas rural patients were more likely to have co-existing severe diseases, such as heart failure comorbid with the sequelae of cerebrovascular disease or COPD. Conclusions: Male-female and urban-rural disparities in the prevalence of single comorbidities and their complex coexistence relationships in new CRC cases were not due to simple coincidence. The results reflect clinical practice in CRC patients and emphasize the importance of measuring comorbidity patterns in terms of individual and coexisting diseases in order to better understand comorbidity patterns. ", doi="10.2196/41999", url="https://publichealth.jmir.org/2023/1/e41999", url="http://www.ncbi.nlm.nih.gov/pubmed/37669093" } @Article{info:doi/10.2196/34589, author="Donegan, Connor and Hughes, E. Amy and Lee, Craddock Simon J.", title="Colorectal Cancer Incidence, Inequalities, and Prevention Priorities in Urban Texas: Surveillance Study With the ``surveil'' Software Package", journal="JMIR Public Health Surveill", year="2022", month="Aug", day="16", volume="8", number="8", pages="e34589", keywords="Bayesian analysis", keywords="cancer prevention", keywords="colorectal cancer", keywords="health equity", keywords="open source software", keywords="public health monitoring", keywords="time-series analysis", abstract="Background: Monitoring disease incidence rates over time with population surveillance data is fundamental to public health research and practice. Bayesian disease monitoring methods provide advantages over conventional methods including greater flexibility in model specification and the ability to conduct formal inference on model-derived quantities of interest. However, software platforms for Bayesian inference are often inaccessible to nonspecialists. Objective: To increase the accessibility of Bayesian methods among health surveillance researchers, we introduce a Bayesian methodology and open source software package, surveil, for time-series modeling of disease incidence and mortality. Given case count and population-at-risk data, the software enables health researchers to draw inferences about underlying risk and derivative quantities including age-standardized rates, annual and cumulative percent change, and measures of inequality. Methods: We specify a Poisson likelihood for case counts and model trends in log-risk using the first-difference (random-walk) prior. Models in the surveil R package were built using the Stan modeling language. We demonstrate the methodology and software by analyzing age-standardized colorectal cancer (CRC) incidence rates by race and ethnicity for non-Latino Black (Black), non-Latino White (White), and Hispanic/Latino (of any race) adults aged 50-79 years in Texas's 4 largest metropolitan statistical areas between 1999 and 2018. Results: Our analysis revealed a cumulative decline of 31\% (95\% CI --37\% to --25\%) in CRC risk among Black adults, 17\% (95\% CI --23\% to --11\%) for Latino adults, and 35\% (95\% CI --38\% to --31\%) for White adults from 1999 to 2018. None of the 3 observed groups experienced significant incidence reduction in the final 4 years of the study (2015-2018). The Black-White rate difference (per 100,000) was 44 (95\% CI 30-57) in 1999 and 35 (95\% CI 28-43) in 2018. Cumulatively, the Black-White gap accounts for 3983 CRC cases (95\% CI 3746-4219) or 31\% (95\% CI 29\%-32\%) of total CRC incidence among Black adults in this period. Conclusions: Stalled progress on CRC prevention and excess CRC risk among Black residents warrant special attention as cancer prevention and control priorities in urban Texas. Our methodology and software can help the public and health agencies monitor health inequalities and evaluate progress toward disease prevention goals. Advantages of the methodology over current common practice include the following: (1) the absence of piecewise linearity constraints on the model space, and (2) formal inference can be undertaken on any model-derived quantities of interest using Bayesian methods. ", doi="10.2196/34589", url="https://publichealth.jmir.org/2022/8/e34589", url="http://www.ncbi.nlm.nih.gov/pubmed/35972778" } @Article{info:doi/10.2196/38874, author="Patel, Sunil and McClintock, Chad and Booth, Christopher and Merchant, Shaila and Heneghan, Carl and Bankhead, Clare", title="The Variations in Care and Real-world Outcomes in Individuals With Rectal Cancer: Protocol for the Ontario Rectal Cancer Cohort", journal="JMIR Res Protoc", year="2022", month="Aug", day="5", volume="11", number="8", pages="e38874", keywords="rectal cancer", keywords="survival", keywords="adherence to care", keywords="regional variability", abstract="Background: Individuals with rectal cancer require a number of pretreatment investigations, often require multidisciplinary treatment, and require ongoing follow-ups after treatment is completed. Due to the complexity of treatments, large variations in practice patterns and outcomes have been identified. At present, few comprehensive, population-level data sets are available for assessing interventions and outcomes in this group. Objective: Our study aims to create a comprehensive database of individuals with rectal cancer who have been treated in a single-payer, universal health care system. This database will provide an excellent resource that investigators can use to study variations in the delivery of care to and real-world outcomes of this population. Methods: The Ontario Rectal Cancer Cohort database will include comprehensive details about the management and outcomes of individuals with rectal cancer who have been diagnosed in Ontario, Canada (population: 14.6 million), between 2010 and 2019. Linked administrative data sets will be used to construct this comprehensive database. Individual and care provider characteristics, investigations, treatments, follow-ups, and outcomes will be derived and linked. Surgical pathology details, including the stage of disease, histopathology characteristics, and the quality of surgical excision, will be included. Ethics approval for this study was obtained through the Queen's University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board. Results: Approximately 20,000 individuals who meet the inclusion criteria for this study have been identified. Data analysis is ongoing, with an expected completion date of March 2023. This study was funded through the Canadian Institute of Health Research Operating Grant. Conclusions: The Ontario Rectal Cancer Cohort will include a comprehensive data set of individuals with rectal cancer who received care within a single-payer, universal health care system. This cohort will be used to determine factors associated with regional variability and adherence to recommended care, and it will allow for an assessment of a number of understudied areas within the delivery of rectal cancer treatment. International Registered Report Identifier (IRRID): RR1-10.2196/38874 ", doi="10.2196/38874", url="https://www.researchprotocols.org/2022/8/e38874", url="http://www.ncbi.nlm.nih.gov/pubmed/35930352" } @Article{info:doi/10.2196/39180, author="Basch, H. Corey and Hillyer, C. Grace and Jacques, T. Erin", title="News Coverage of Colorectal Cancer on Google News: Descriptive Study", journal="JMIR Cancer", year="2022", month="Jun", day="15", volume="8", number="2", pages="e39180", keywords="colorectal cancer", keywords="internet", keywords="online news", keywords="screening", keywords="disparities", keywords="infodemiology", keywords="online health information", keywords="content analysis", keywords="public awareness", keywords="health news", keywords="cancer screening", keywords="health video", keywords="video content analysis", abstract="Background: Colorectal cancer (CRC) is one of the leading causes of cancer death in the United States. The incidence and prevalence of CRC have historically increased with age. Although rates of CRC in the United States have been decreasing over the past decades among those aged ?65 years, there has been an uptick among those in younger age brackets. Google News is one of the biggest traffic drivers to top news sites. It aggregates and shares news highlights from multiple sources worldwide and organizes them by content type. Despite the widespread use of Google News, research is lacking on the type of CRC content represented in this news source.? Objective: The purpose of this study was to analyze content related to CRC screening and prevention in Google News articles published during National Colorectal Cancer Awareness Month (March 2022). Methods: Data collection for this cross-sectional study was conducted in March 2022---National Colorectal Cancer Awareness Month.?Using the term colorectal cancer, 100 English-language Google News articles were extracted and coded for content. A combined approach---deductive and inductive coding---was utilized. Descriptive analyses were conducted, and frequency distributions were reported. Univariable analyses were performed to assess differences between articles that mentioned CRC screening and those that did not via chi-square tests. Results: Of the 100 articles reviewed, nearly half (n=49, 49\%) were created by health news organizations, and another 27\% (n=27) were created by television news services.?The predominant themes in the content included age at the onset of disease (n=59, 59\%), mortality related to CRC (n=57, 57\%), and the severity of disease (n=50, 50\%).?Only 18\% (n=18) of articles discussed CRC disparities, 23\% (n=23) mentioned that there are hereditary forms of the disease, 36\% (n=36) spoke of colonoscopy to screen for the disease, and 37\% (n=37) mentioned how the disease is treated.?Although most articles mentioned CRC screening (n=61, 61\%), it was striking that sex was only mentioned in 34\% (21/61) of these articles, colonoscopy was mentioned in 46\% (28/61), and diet was mentioned in 30\% (18/61). Conclusions: Heightening the public's awareness of this disease is important, but it is critical that messages related to how preventable this cancer is, who is the most likely to develop CRC, and what can be done to detect it in the early stages when the disease is the most curable be the critical elements of dialogue, particularly during National Colorectal Cancer Awareness Month. There is a need to disseminate information about early-onset CRC and the importance of screening, especially among populations with low rates of uptake. Web-based news is potentially an underutilized communication mechanism for promoting CRC screenings as secondary prevention measures for high-risk groups. ", doi="10.2196/39180", url="https://cancer.jmir.org/2022/2/e39180", url="http://www.ncbi.nlm.nih.gov/pubmed/35704377" } @Article{info:doi/10.2196/34292, author="Regueiro, Cristina and Codesido, Laura and Garc{\'i}a-Nimo, Laura and Zarraqui{\~n}os, Sara and Remedios, David and Rodr{\'i}guez-Blanco, Arturo and Sinde, Esteban and Fern{\'a}ndez-de-Ana, Catalina and Cubiella, Joaqu{\'i}n", title="Effect of the Nutraceutical Micodigest 2.0 on the Complication Rate of Colorectal Cancer Surgery With Curative Intent: Protocol for a Placebo-Controlled Double-blind Randomized Clinical Trial", journal="JMIR Res Protoc", year="2022", month="May", day="16", volume="11", number="5", pages="e34292", keywords="colorectal cancer", keywords="surgery complications", keywords="gut microbiota", keywords="inflammatory pattern", keywords="nutritional status", keywords="nutraceutical", keywords="postsurgery", keywords="colorectal", keywords="cancer", keywords="colon", abstract="Background: Most colorectal cancer patients diagnosed are candidates for surgical resection with curative intent, although colorectal surgery is associated with some complications that could be life-threatening. Antibiotic prophylaxis is commonly used for the prevention of infectious postoperative complications. However, this intervention can change the composition of intestinal microbiota and promote adverse inflammatory outcomes in colorectal cancer patients. The combination of different fungal extracts could be beneficial because of their role in gut microbiota modulation and their anti-inflammatory activity. Objective: Based on this hypothesis, we have designed a double-bind, randomized clinical trial to evaluate the effect of the nutraceutical fungal extract Micodigest 2.0 on complications of surgery for colorectal cancer resection. Methods: Colorectal cancer candidates for surgery will be considered for inclusion in the study. After evaluation by the multidisciplinary tumor board, patients who meet selection criteria will be screened, stratified according to tumor location, and randomly allocated to be treated with Micodigest 2.0 or placebo. Treatment will be continued until admission for surgery (4-6 weeks). Participants will undergo a medical and clinical evaluation including baseline and preadmission quality of life, microbiome composition, inflammatory and nutritional status, adverse events, and adherence assessments. The main end point of the study is the surgery complication rate. We will evaluate complications using the Clavien-Dindo classification. It will be necessary to recruit 144 patients to find a relevant clinical difference. We will also evaluate the effect of the nutraceutical on microbiome composition, inflammatory response, nutritional status, and quality of life, as well as the effect of these variables on surgical complications. Results: This study was funded in 2020 by the Center for Industrial Technology Development. Recruitment began in September 2021 and is expected to be completed in September 2022. Data will be analyzed and the results will be disseminated in 2023. Conclusions: The results of this protocol study could help to reduce surgery complications in patients with colorectal cancer using the new treatment Micodigest. This study could also identify new features associated with colorectal surgery complications. In summary, this study trial could improve the management of colorectal cancer patients. Trial Registration: Clinical Trials.gov NCT04821258; https://clinicaltrials.gov/ct2/show/NCT04821258 International Registered Report Identifier (IRRID): DERR1-10.2196/34292 ", doi="10.2196/34292", url="https://www.researchprotocols.org/2022/5/e34292", url="http://www.ncbi.nlm.nih.gov/pubmed/35576566" } @Article{info:doi/10.2196/16447, author="Haggstrom, A. David and Carr, Thomas", title="Uses of Personal Health Records for Communication Among Colorectal Cancer Survivors, Caregivers, and Providers: Interview and Observational Study in a Human-Computer Interaction Laboratory", journal="JMIR Hum Factors", year="2022", month="Jan", day="25", volume="9", number="1", pages="e16447", keywords="personal health record", keywords="communication", keywords="cancer survivorship", keywords="colorectal cancer", abstract="Background: Personal health records (PHRs) may be useful for patient self-management and participation in communication with their caregivers and health care providers. As each potential participant's role is different, their perception of the best uses of a PHR may vary. Objective: The perspectives of patients, caregivers, and providers were all evaluated concurrently in relation to a PHR developed for colorectal cancer (CRC) survivors. Methods: We explored group perceptions of a CRC PHR prototype. Scenario-based testing across eight use cases, with semistructured follow-up interviews, was videotaped in a human-computer interaction laboratory with patients, caregivers, and health care providers. Providers included oncologists, gastroenterologists, and primary care physicians. Discrete observations underwent grounded theory visual affinity analysis to identify emergent themes. Results: Observations fell into three major themes: the network (who should be granted access to the PHR by the patient), functions (helpful activities the PHR enabled), and implementation (how to adopt the PHR into workflow). Patients wanted physician access to their PHR, as well as family member access, especially when they lived at a distance. All groups noted the added value of linking the PHR to an electronic health record, self-tracking, self-management, and secure messaging. Patients and caregivers also saw information in the PHR as a useful memory tool given their visits to multiple doctors. Providers had reservations about patients viewing raw data, which they were not prepared to interpret or might be inaccurate; patients and caregivers did not express any reservations about having access to more information. Patients saw PHR communication functions as a potential tool for relationship building. Patients and caregivers valued the journal as a tool for reflection and delivery of emotional support. Providers felt the PHR would facilitate patient-physician communication but worried that sharing journal access would make the doctor-patient relationship less professional and had reservations about the time burden of reviewing. Strategies suggested for efficient adoption into workflow included team delegation. Establishment of parameters for patient uses and provider responses was perceived as good standard practice. Conclusions: PHR perceptions differed by role, with providers seeing the PHR as informational, while patients and caregivers viewed the tool as more relational. Personal health records should be linked to electronic health records for ease of use. Tailoring access, content, and implementation of the PHR is essential. Technology changes have the potential to change the nature of the patient-physician relationship. Patients and providers should establish shared expectations about the optimal use of the PHR and explore how emerging patient-centered technologies can be successfully implemented in modern medical practice to improve the relational quality of care. ", doi="10.2196/16447", url="https://humanfactors.jmir.org/2022/1/e16447", url="http://www.ncbi.nlm.nih.gov/pubmed/35076406" } @Article{info:doi/10.2196/18083, author="Ayyoubzadeh, Mohammad Seyed and Shirkhoda, Mohammad and R Niakan Kalhori, Sharareh and Mohammadzadeh, Niloofar and Zakerabasali, Somayyeh", title="A Smartphone Remote Monitoring App to Follow Up Colorectal Cancer Survivors: Requirement Analysis", journal="JMIR Cancer", year="2022", month="Jan", day="5", volume="8", number="1", pages="e18083", keywords="eHealth", keywords="app", keywords="colorectal cancer", keywords="survivors", keywords="requirements analysis", keywords="MoSCoW", abstract="Background: Colorectal cancer survivors face multiple challenges after discharge. eHealth may potentially support them by providing tools such as smartphone apps. They have lots of capabilities to exchange information and could be used for remote monitoring of these patients. Objective: In this study, we addressed the required features for apps designed to follow up colorectal cancer patients based on survivors' and clinical experts' views. Methods: A mixed methods study was conducted. Features of related apps were extracted through the literature; the features were categorized, and then, they were modified. A questionnaire was designed containing the features listed and prioritized based on the MoSCoW (Must have, Should have, Could have, Won't have) technique and an open question for each category. The link to the questionnaire was shared among clinical experts in Iran. The answers were analyzed using the content validity ratio (CVR), and based on the value of this measure, the minimum feature set of a monitoring app to follow up patients with colorectal cancer was addressed. In addition, a telephone interview with colorectal cancer survivors was conducted to collect their viewpoints regarding a remote monitoring system for colorectal cancer cases. Results: The questionnaire contained 10 sections evaluating 9 categories of features. The questionnaire was completed by 18 experts. The minimum set of features in the app was identified as patient information registration, sign and symptom monitoring, education, reminders, and patient evaluation (0.42 < CVR < 0.85). Features including physical activity, personalized advice, and social network did not achieve the minimum score (--0.11 < CVR < 0.39). We interviewed 9 colorectal cancer survivors. Information registration, sign and symptom monitoring, education, and personalized advice were the features with high priority from the survivors' perspectives. Scheduling, shopping, and financial support features were emphasized by survivors in the interview. Conclusions: The requirement set could be used to design an app for the targeted population or patients affected by other cancers. As the views from both survivors and clinical experts were considered in this study, the remote system may more adequately fulfill the need for follow-up of survivors. This eases the patients' and health care providers' communication and interaction. ", doi="10.2196/18083", url="https://cancer.jmir.org/2022/1/e18083", url="http://www.ncbi.nlm.nih.gov/pubmed/34989685" } @Article{info:doi/10.2196/28709, author="Wilson-Howard, Danyell and Vilaro, J. Melissa and Neil, M. Jordan and Cooks, J. Eric and Griffin, N. Lauren and Ashley, T. Taylor and Tavassoli, Fatemeh and Zalake, S. Mohan and Lok, C. Benjamin and Odedina, T. Folakemi and Modave, Francois and Carek, J. Peter and George, J. Thomas and Krieger, L. Janice", title="Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study", journal="JMIR Form Res", year="2021", month="Dec", day="24", volume="5", number="12", pages="e28709", keywords="telehealth", keywords="digital health", keywords="eHealth", keywords="colorectal cancer", keywords="Black men", keywords="virtual human", keywords="technology", keywords="cancer screening", keywords="app", keywords="cancer", keywords="prevention", keywords="development", abstract="Background: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one's home. Objective: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user's psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as ``brother-doctor,'' and participants stated ``wanting to interact with ALEX over their regular doctor.'' Conclusions: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men. ", doi="10.2196/28709", url="https://formative.jmir.org/2021/12/e28709", url="http://www.ncbi.nlm.nih.gov/pubmed/34780346" } @Article{info:doi/10.2196/31128, author="Shahzadi, Kiran Syeda and Karuvantevida, Noushad and Banerjee, Yajnavalka", title="A Venomics Approach to the Identification and Characterization of Bioactive Peptides From Animal Venoms for Colorectal Cancer Therapy: Protocol for a Proof-of-Concept Study", journal="JMIR Res Protoc", year="2021", month="Dec", day="21", volume="10", number="12", pages="e31128", keywords="animal venoms", keywords="colorectal cancer", keywords="bioactive peptides", keywords="high-throughput screening", keywords="venom", keywords="cancer", keywords="colorectal", keywords="peptide", keywords="screening", keywords="treatment", keywords="conceptual", keywords="characterize", keywords="development", keywords="therapy", abstract="Background: Cancer is the third leading cause of death in the United Arab Emirates (UAE), after cardiovascular diseases and accidents. In the UAE, colorectal cancer (CRC) is the first and fourth most common cancer in males and females, respectively. Several treatment modalities have been employed for cancer treatment, such as surgery, radiotherapy, chemotherapy, hormone replacement therapy, and immunotherapy. These treatment modalities often elicit adverse effects on normal cells, causing toxic side effects. To circumvent these toxicities, there has been an increased impetus towards the identification of alternate treatment strategies. Animal venoms are rich sources of pharmacologically active polypeptides and proteins. Objective: In this proof-of-concept study, we will apply a high-throughput venomics strategy to identify and characterize anticancer bioactive peptides (BAPs) from 20 different animal venoms, specifically targeting CRC. We chose to focus on CRC because it is one of the foremost health issues in the UAE. Methods: In the initial study, we will screen 2500 different peptides derived from 20 different animal venoms for anticancer activity specifically directed against 3 CRC cell lines and two control cell lines employing the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay for cytotoxicity. Of the 20 venoms, 3 that exhibit specific and potent anticancer activity directed against the 3 CRC cell lines will be selected; and from these 3 venoms, the specific peptides with anti-CRC activity will be isolated and characterized. Results: This study is at the protocol development stage only, and as such, no results are available. However, we have initiated the groundwork required to disseminate the proposed study, which includes culturing of colorectal cancer cell lines and preparation of venom screens. Conclusions: In summary, the proposed study will generate therapeutic leads to manage and treat one of the leading health issues in the UAE, namely, CRC. International Registered Report Identifier (IRRID): PRR1-10.2196/31128 ", doi="10.2196/31128", url="https://www.researchprotocols.org/2021/12/e31128", url="http://www.ncbi.nlm.nih.gov/pubmed/34932002" } @Article{info:doi/10.2196/31917, author="Wan, Wei Su and Chong, Seng Choon and Toh, Ee-Lin and Lim, Hoon Siew and Loi, TT Carol and Lew, Henry Yuen Foong and Chua, Heng Matthew Chin and Jee, Pei Xin and Liu, Guangyu and Zhu, Lixia and Pikkarainen, Minna and He, Hong-Gu", title="A Theory-Based, Multidisciplinary Approach to Cocreate a Patient-Centric Digital Solution to Enhance Perioperative Health Outcomes Among Colorectal Cancer Patients and Their Family Caregivers: Development and Evaluation Study", journal="J Med Internet Res", year="2021", month="Dec", day="7", volume="23", number="12", pages="e31917", keywords="colorectal cancer", keywords="digital solutions", keywords="mobile health", keywords="psychosocial", keywords="mHealth", keywords="smartphone app", keywords="mobile phone app", abstract="Background: Elective colorectal cancer (CRC) surgeries offer enhanced surgical outcomes but demand high self-efficacy in prehabilitation and competency in self-care and disease management postsurgery. Conventional strategies to meet perioperative needs have not been pragmatic, and there remains a pressing need for novel technologies that could improve health outcomes. Objective: The aim of this paper was to describe the development of a smartphone-based interactive CRC self-management enhancement psychosocial program (iCanManage) in order to improve health outcomes among patients who undergo elective CRC surgeries and their family caregivers. Methods: A multidisciplinary international team comprising physicians, specialist nurses, a psychologist, software engineers, academic researchers, cancer survivors, patient ambassadors, and ostomy care medical equipment suppliers was formed to facilitate the development of this patient-centric digital solution. The process occurred in several stages: (1) review of current practice through clinic visits and on-site observations; (2) review of literature and findings from preliminary studies; (3) content development grounded in an underpinning theory; (4) integration of support services; and (5) optimizing user experience through improving interface aesthetics and customization. In our study, 5 participants with CRC performed preliminary assessments on the quality of the developed solution using the 20-item user version of the Mobile App Rating Scale (uMARS), which had good psychometric properties. Results: Based on the collected uMARS data, the smartphone app was rated highly for functionality, aesthetics, information quality, and perceived impact, and moderately for engagement and subjective quality. Several limiting factors such as poor agility in the adoption of digital technology and low eHealth literacy were identified despite efforts to promote engagement and ensure ease of use of the mobile app. To overcome such barriers, additional app-training sessions, an instruction manual, and regular telephone calls will be incorporated into the iCanManage program during the trial period. Conclusions: This form of multidisciplinary collaboration is advantageous as it can potentially streamline existing care paths and allow the delivery of more holistic care to the CRC population during the perioperative period. Should the program be found to be effective and sustainable, hospitals adopting this digital solution may achieve better resource allocation and reduce overall health care costs in the long run. Trial Registration: ClinicalTrials.gov NCT04159363; https://clinicaltrials.gov/ct2/show/NCT04159363 ", doi="10.2196/31917", url="https://www.jmir.org/2021/12/e31917", url="http://www.ncbi.nlm.nih.gov/pubmed/34878991" } @Article{info:doi/10.2196/29682, author="Bang, Seok Chang and Lee, Jun Jae and Baik, Ho Gwang", title="Computer-Aided Diagnosis of Diminutive Colorectal Polyps in Endoscopic Images: Systematic Review and Meta-analysis of Diagnostic Test Accuracy", journal="J Med Internet Res", year="2021", month="Aug", day="25", volume="23", number="8", pages="e29682", keywords="artificial intelligence", keywords="deep learning", keywords="polyps", keywords="colon", keywords="colonoscopy", keywords="diminutive", abstract="Background: Most colorectal polyps are diminutive and benign, especially those in the rectosigmoid colon, and the resection of these polyps is not cost-effective. Advancements in image-enhanced endoscopy have improved the optical prediction of colorectal polyp histology. However, subjective interpretability and inter- and intraobserver variability prohibits widespread implementation. The number of studies on computer-aided diagnosis (CAD) is increasing; however, their small sample sizes limit statistical significance. Objective: This review aims to evaluate the diagnostic test accuracy of CAD models in predicting the histology of diminutive colorectal polyps by using endoscopic images. Methods: Core databases were searched for studies that were based on endoscopic imaging, used CAD models for the histologic diagnosis of diminutive colorectal polyps, and presented data on diagnostic performance. A systematic review and diagnostic test accuracy meta-analysis were performed. Results: Overall, 13 studies were included. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of diminutive colorectal polyps (adenomatous or neoplastic vs nonadenomatous or nonneoplastic) were 0.96 (95\% CI 0.93-0.97), 0.93 (95\% CI 0.91-0.95), 0.87 (95\% CI 0.76-0.93), and 87 (95\% CI 38-201), respectively. The meta-regression analysis showed no heterogeneity, and no publication bias was detected. Subgroup analyses showed robust results. The negative predictive value of CAD models for the diagnosis of adenomatous polyps in the rectosigmoid colon was 0.96 (95\% CI 0.95-0.97), and this value exceeded the threshold of the diagnosis and leave strategy. Conclusions: CAD models show potential for the optical histological diagnosis of diminutive colorectal polyps via the use of endoscopic images. Trial Registration: PROSPERO CRD42021232189; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=232189 ", doi="10.2196/29682", url="https://www.jmir.org/2021/8/e29682", url="http://www.ncbi.nlm.nih.gov/pubmed/34432643" } @Article{info:doi/10.2196/16846, author="Humphry, Angharad Nia and Wilson, Thomas and Cox, Christian Michael and Carter, Ben and Arkesteijn, Marco and Reeves, Laura Nicola and Brakenridge, Scott and McCarthy, Kathryn and Bunni, John and Draper, John and Hewitt, Jonathan", title="Association of Postoperative Clinical Outcomes With Sarcopenia, Frailty, and Nutritional Status in Older Patients With Colorectal Cancer: Protocol for a Prospective Cohort Study", journal="JMIR Res Protoc", year="2021", month="Aug", day="17", volume="10", number="8", pages="e16846", keywords="sarcopenia", keywords="frailty", keywords="nutritional status", keywords="urine metabolomics", keywords="surgery", keywords="geriatric medicine", abstract="Background: Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Although each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. A particular area of increasing interest is the use of urine metabolomics for the objective evaluation of dietary profiles and malnutrition. Objective: Herein, we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. The objectives are to determine the association between clinical outcomes and frailty, nutritional status, and sarcopenia. Methods: The procedures will include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (hand grip strength and 4-meter walk test), muscle mass evaluations via computerized tomography morphometric analysis, and the evaluation of nutritional status via the analysis of urinary dietary biomarkers. The primary feasibility outcome is the estimation of the incidence rate of postoperative complications, and the primary clinical outcome is the association between the presence of postoperative complications and frailty, sarcopenia, and nutritional status. The secondary outcome measures are the length of hospital stay, 30-day hospital readmission rate, and mortality rate at days 30 and 90. Results: Our study was approved by the National Health Service Research Ethics Committee (reference number: 19/WA/0190) via the Integrated Research Application System (project ID: 231694) prior to subject recruitment. Cardiff University is acting as the study sponsor. Our study is financially supported through an external, peer-reviewed grant from the British Geriatrics Society and internal funding resources from Cardiff University. The results will be disseminated through peer-review publications, social media, and conference proceedings. Conclusions: As frailty, sarcopenia, and malnutrition are all areas of common derangement in the older surgical population, prospectively studying these risk factors in concert will allow for the analysis of their interplay as well as the development of predictive models for those at risk of commonly tracked surgical complications and outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/16846 ", doi="10.2196/16846", url="https://www.researchprotocols.org/2021/8/e16846", url="http://www.ncbi.nlm.nih.gov/pubmed/34402798" } @Article{info:doi/10.2196/27370, author="Nazarian, Scarlet and Glover, Ben and Ashrafian, Hutan and Darzi, Ara and Teare, Julian", title="Diagnostic Accuracy of Artificial Intelligence and Computer-Aided Diagnosis for the Detection and Characterization of Colorectal Polyps: Systematic Review and Meta-analysis", journal="J Med Internet Res", year="2021", month="Jul", day="14", volume="23", number="7", pages="e27370", keywords="artificial intelligence", keywords="colonoscopy", keywords="computer-aided diagnosis", keywords="machine learning", keywords="polyp", abstract="Background: Colonoscopy reduces the incidence of colorectal cancer (CRC) by allowing detection and resection of neoplastic polyps. Evidence shows that many small polyps are missed on a single colonoscopy. There has been a successful adoption of artificial intelligence (AI) technologies to tackle the issues around missed polyps and as tools to increase the adenoma detection rate (ADR). Objective: The aim of this review was to examine the diagnostic accuracy of AI-based technologies in assessing colorectal polyps. Methods: A comprehensive literature search was undertaken using the databases of Embase, MEDLINE, and the Cochrane Library. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Studies reporting the use of computer-aided diagnosis for polyp detection or characterization during colonoscopy were included. Independent proportions and their differences were calculated and pooled through DerSimonian and Laird random-effects modeling. Results: A total of 48 studies were included. The meta-analysis showed a significant increase in pooled polyp detection rate in patients with the use of AI for polyp detection during colonoscopy compared with patients who had standard colonoscopy (odds ratio [OR] 1.75, 95\% CI 1.56-1.96; P<.001). When comparing patients undergoing colonoscopy with the use of AI to those without, there was also a significant increase in ADR (OR 1.53, 95\% CI 1.32-1.77; P<.001). Conclusions: With the aid of machine learning, there is potential to improve ADR and, consequently, reduce the incidence of CRC. The current generation of AI-based systems demonstrate impressive accuracy for the detection and characterization of colorectal polyps. However, this is an evolving field and before its adoption into a clinical setting, AI systems must prove worthy to patients and clinicians. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020169786; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42020169786 ", doi="10.2196/27370", url="https://www.jmir.org/2021/7/e27370", url="http://www.ncbi.nlm.nih.gov/pubmed/34259645" } @Article{info:doi/10.2196/resprot.5495, author="Bordonaro, Michael and Lazarova, Lazarova Darina", title="Determination of the Role of CBP- and p300-Mediated Wnt Signaling on Colonic Cells", journal="JMIR Res Protoc", year="2016", month="May", day="13", volume="5", number="2", pages="e66", keywords="Wnt", keywords="butyrate", keywords="beta-catenin", keywords="CBP", keywords="p300", keywords="histone acetylation", keywords="colorectal cancer", abstract="Background: The Wnt signaling pathway, mediated through active beta-catenin, is responsible for initiating the majority of cases of human colorectal cancer (CRC), and we have previously shown that hyperactivation of this pathway by histone deacetylase inhibitors (HDACis), such as butyrate, can induce the death of CRC cells. An important cellular switch that mediates the effects of Wnt-signaling activation is variation in the association between beta-catenin and the transcriptional coactivators cAMP response element binding (CREB) binding protein (CBP) and p300. Association of CBP with beta-catenin is thought to activate a set of genes linked to cell proliferation, while the p300-mediated Wnt genetic program is believed to promote cell differentiation. Small molecule agents have been discovered that modulate CBP/p300 Wnt transcriptional programs by altering the association of CBP and p300 to beta-catenin. ICG-001 and ICG-427 inhibit CBP- and p300-mediated Wnt activity, respectively, while IQ-1 prevents the shift from CBP-mediated to a p300-mediated Wnt activity. Objective: Aim 1 of this proposal is designed to determine the role of CBP- and p300-mediated Wnt signaling in the response of CRC cells to HDACis. Aim 2 is to determine the role of CBP and p300 in the maintenance of high- and low-Wnt fractions in CRC cell line. Aim 3 will compare the effects of CBP- and p300-mediated Wnt activity on CRC initiation and progression. Methods: In Aim 1, cells will be cotreated with HDACis and ICG-001, ICG-427, or IQ-1 and the levels of Wnt activity, apoptosis, proliferation, differentiation, and CBP- or p300-beta-catenin binding measured. Aim 2 of this proposal may mirror similar heterogeneity observed in human tumors and which may be of clinical significance. Aim 3 will use CRC cell line model systems of initiation and progression: the normal colon cell lines CCD-841CoN, the adenoma line LT97, the primary colon carcinoma cell line SW480, and the lymph node metastasis cell line SW620. Cells will be treated with HDACis and the small molecule agents, and assayed as described above. Results: We will also attempt to use changes in CBP- and p300-mediated Wnt signaling to shift colonic cells between cell type, modifying CBP- and p300-mediated gene expression in the LT97 adenoma line to shift the adenoma phenotype to more characteristic of the CCD-841CoN normal cells, or the SW480 carcinoma cells. We will use microarray analyses to determine the patterns of gene expression responsible for these CBP- or p300-mediated changes in colonic neoplastic phenotype. Conclusions: The findings generated from this study will lead to future, more in-depth projects to further dissect the action of CBP/p300 Wnt--mediated transcriptional programs in colonic neoplasia, with an emphasis on methods to modulate these genetic programs for chemopreventive effect. ", doi="10.2196/resprot.5495", url="http://www.researchprotocols.org/2016/2/e66/", url="http://www.ncbi.nlm.nih.gov/pubmed/27177606" }