Abstract
Objectives: Formal efforts to improve patient education are associated with fewer disease complications in a number of conditions. The possible relationship between knowledge about ulcerative colitis and its cancer risk, and the development of colorectal cancer using a previously developed and validated instrument—the Crohn's and colitis knowledge (CCKNOW) score—were investigated.
Methods: The 24 item CCKNOW questionnaire was mailed to patients known to have developed colorectal cancer as a complication of ulcerative colitis (cases) and to colitics from the Leicestershire inflammatory bowel disease patient database who had not developed cancer (controls).
Results: The mean (SD) CCKNOW scores for cases was 8.21 (3.02) and for controls was 8.27 (4.3). These scores did not differ significantly between cases and controls (difference 0.06, 95% confidence interval (CI) -1.7 to 1.5, p=0.9). There were four times as many members of the National Association of Crohn's and Colitis (NACC) in the control group compared with the cancer group and patients who are members of NACC achieve statistically significantly higher scores than non-members (11.6 v 7.8, p=0.05, 95% CI -0.1 to 7.6). However, after adjusting for NACC membership, the CCKNOW score did not appear to be associated with having developed cancer (odds ratio 1.04, 95% CI 0.92 to 1.18, p=0.5).
Conclusions: The CCKNOW scores were comparable in cases and controls. Thus, in a retrospective study, no evidence has been demonstrated of an association between patient knowledge and the risk of developing colorectal cancer in patients with ulcerative colitis. However, knowledge may have been increased in cases as a direct result of having had colorectal cancer as a complication of ulcerative colitis.
Full Text
The Full Text of this article is available as a PDF (101.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Choi P. M., Nugent F. W., Schoetz D. J., Jr, Silverman M. L., Haggitt R. C. Colonoscopic surveillance reduces mortality from colorectal cancer in ulcerative colitis. Gastroenterology. 1993 Aug;105(2):418–424. doi: 10.1016/0016-5085(93)90715-o. [DOI] [PubMed] [Google Scholar]
- Choy D. K., Tong M., Ko F., Li S. T., Ho A., Chan J., Leung R., Lai C. K. Evaluation of the efficacy of a hospital-based asthma education programme in patients of low socioeconomic status in Hong Kong. Clin Exp Allergy. 1999 Jan;29(1):84–90. doi: 10.1046/j.1365-2222.1999.00481.x. [DOI] [PubMed] [Google Scholar]
- Eaden J. A., Abrams K., Mayberry J. F. The Crohn's and Colitis Knowledge Score: a test for measuring patient knowledge in inflammatory bowel disease. Am J Gastroenterol. 1999 Dec;94(12):3560–3566. doi: 10.1111/j.1572-0241.1999.01536.x. [DOI] [PubMed] [Google Scholar]
- Eaden J., Abrams K., Ekbom A., Jackson E., Mayberry J. Colorectal cancer prevention in ulcerative colitis: a case-control study. Aliment Pharmacol Ther. 2000 Feb;14(2):145–153. doi: 10.1046/j.1365-2036.2000.00698.x. [DOI] [PubMed] [Google Scholar]
- Ekbom A., Helmick C., Zack M., Adami H. O. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med. 1990 Nov 1;323(18):1228–1233. doi: 10.1056/NEJM199011013231802. [DOI] [PubMed] [Google Scholar]
- Karlén P., Kornfeld D., Broström O., Löfberg R., Persson P. G., Ekbom A. Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control study. Gut. 1998 May;42(5):711–714. doi: 10.1136/gut.42.5.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lindberg B., Persson B., Veress B., Ingelman-Sundberg H., Granqvist S. Twenty years' colonoscopic surveillance of patients with ulcerative colitis. Detection of dysplastic and malignant transformation. Scand J Gastroenterol. 1996 Dec;31(12):1195–1204. doi: 10.3109/00365529609036910. [DOI] [PubMed] [Google Scholar]
- Moody G. A., Jayanthi V., Probert C. S., Mac Kay H., Mayberry J. F. Long-term therapy with sulphasalazine protects against colorectal cancer in ulcerative colitis: a retrospective study of colorectal cancer risk and compliance with treatment in Leicestershire. Eur J Gastroenterol Hepatol. 1996 Dec;8(12):1179–1183. doi: 10.1097/00042737-199612000-00009. [DOI] [PubMed] [Google Scholar]
- Pinczowski D., Ekbom A., Baron J., Yuen J., Adami H. O. Risk factors for colorectal cancer in patients with ulcerative colitis: a case-control study. Gastroenterology. 1994 Jul;107(1):117–120. doi: 10.1016/0016-5085(94)90068-x. [DOI] [PubMed] [Google Scholar]
- Provenzale D., Onken J. Surveillance issues in inflammatory bowel disease: ulcerative colitis. J Clin Gastroenterol. 2001 Feb;32(2):99–105. doi: 10.1097/00004836-200102000-00003. [DOI] [PubMed] [Google Scholar]
- Ransohoff D. F. Colon cancer in ulcerative colitis. Gastroenterology. 1988 Apr;94(4):1089–1091. doi: 10.1016/0016-5085(88)90573-2. [DOI] [PubMed] [Google Scholar]
- Surawy C. Knowledge about diabetes in type 1 patients is related to metabolic control. Diabet Med. 1989 Dec;6(9):784–786. doi: 10.1111/j.1464-5491.1989.tb01279.x. [DOI] [PubMed] [Google Scholar]
- Tan A. S., Yong L. S., Wan S., Wong M. L. Patient education in the management of diabetes mellitus. Singapore Med J. 1997 Apr;38(4):156–160. [PubMed] [Google Scholar]