Grant Number:	1R01CA155347-01A1 Interpret this number
Primary Investigator:	Weinberg, David
Organization:	Fox Chase Cancer Center
Project Title:	Comparative Effectiveness of Virtual and Optical Colonoscopy for Crc Surveillance
Fiscal Year:	2011

DESCRIPTION (provided by applicant): The objective of this application is to compare the clinical effectiveness and the cost-effectiveness of CT colonography (CTC) to optical colonoscopy (OC) in the detection of colon polyps and cancers in the post- resection surveillance setting. There are more than 1,000,000 survivors of colorectal cancer (CRC) in the US with approximately 150,000 new cases annually. Nearly all are eligible to participate in well accepted post- operative surveillance strategies. Clinical guidelines advocate annual abdominal/pelvic CT scan and OC one year after surgery and then every three years. Recently, CTC which combines CT imaging of abdomino-pelvic contents with intra-luminal colonic imaging has garnered attention as an option for routine CRC screening. We hypothesize it may also prove a cost-effective, clinically useful substitute for independent CT scan and OC as a surveillance technique. In our study, CRC patients (n=1000) from the Fox Chase Cancer Center, University of Wisconsin and the Mayo Clinic (Rochester), one year removed from curative resection, who have completed other cancer therapy, will undergo CTC examination with same day OC to follow. Participants will also provide questionnaire responses regarding preferences about CTC vs. separate imaging and endoscopic procedures. The study has three Specific Aims: 1. To evaluate the test characteristics (sensitivity, specificity, positive and negative predictive value) of CT colonography (CTC) for detecting colorectal adenomas and cancers in the post-resection surveillance setting, using optical colonoscopy (OC) as the reference standard. 2. To compare the costs and outcomes, from the payor's and society's perspectives, of CTC versus independent OC plus CT for post-resection surveillance, using standard methods of cost-effectiveness analysis. 3. To assess patient preference for CTC versus separate radiologic and endoscopic evaluation in the post-resection surveillance setting. Approximately 48 months of enrollment is anticipated. Adequate statistical power will exist to demonstrate that the sensitivity and specificity of CTC are not significantly less than 90% relative to OC. In addition, we will generate cost-effectiveness models from the payor and societal perspectives investigating the role of CTC in post-operative surveillance. Data management and analysis will be completed at Fox Chase. An important, but largely unstudied, potential role for CTC is as a component of post-operative surveillance. If CTC is found to be a safe, clinically similar alternative to OC, but more cost-effective and/or preferred by patients, this would provide evidence based support for incorporation of CTC in surveillance recommendations after potentially curative CRC surgery. PUBLIC HEALTH RELEVANCE: There are 150,000 new cases of colorectal cancer (CRC) annually and over 1 million CRC survivors. Patients with a history of CRC are at elevated risk for subsequent colorectal cancers. This project compares CT colonography (virtual colonoscopy) to the combination of CT plus optical colonoscopy as post-operative surveillance techniques to prevent, or to detect new CRCs earlier and in a more cost-effective manner.




Reevaluating the Evidence for Intensive Postoperative Extracolonic Surveillance for Nonmetastatic Colorectal Cancer.
Authors: Popp J. , Weinberg D.S. , Enns E. , Nyman J.A. , Beck J.R. , Kuntz K.M. .
Source: Value In Health : The Journal Of The International Society For Pharmacoeconomics And Outcomes Research, 2022 01; 25(1), p. 36-46.
EPub date: 2021-10-13 00:00:00.0.
PMID: 35031098
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Cost-effectiveness of surveillance with CT colonography after resection of colorectal cancer.
Authors: Kuntz K.M. , Popp J. , Beck J.R. , Zauber A.G. , Weinberg D.S. .
Source: Bmj Open Gastroenterology, 2020 Sep; 7(1), .
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Noninvasive Detection of Colorectal Carcinomas Using Serum Protein Biomarkers.
Authors: Ivancic M.M. , Megna B.W. , Sverchkov Y. , Craven M. , Reichelderfer M. , Pickhardt P.J. , Sussman M.R. , Kennedy G.D. .
Source: The Journal Of Surgical Research, 2020 02; 246, p. 160-169.
EPub date: 2019-10-03 00:00:00.0.
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Post-operative colorectal cancer surveillance: preference for optical colonoscopy over computerized tomographic colonography.
Authors: Weinberg D.S. , Mitnick J. , Keenan E. , Li T. , Ross E.A. .
Source: Cancer Causes & Control : Ccc, 2019-09-17 00:00:00.0; , .
EPub date: 2019-09-17 00:00:00.0.
PMID: 31531798
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Conserved serum protein biomarkers associated with growing early colorectal adenomas.
Authors: Ivancic M.M. , Anson L.W. , Pickhardt P.J. , Megna B. , Pooler B.D. , Clipson L. , Reichelderfer M. , Sussman M.R. , Dove W.F. .
Source: Proceedings Of The National Academy Of Sciences Of The United States Of America, 2019-04-23 00:00:00.0; 116(17), p. 8471-8480.
EPub date: 2019-04-10 00:00:00.0.
PMID: 30971492
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Adherence to postresection colorectal cancer surveillance at National Cancer Institute-designated Comprehensive Cancer Centers.
Authors: Kupfer S.S. , Lubner S. , Coronel E. , Pickhardt P.J. , Tipping M. , Graffy P. , Keenan E. , Ross E. , Li T. , Weinberg D.S. .
Source: Cancer Medicine, 2018-10-18 00:00:00.0; , .
EPub date: 2018-10-18 00:00:00.0.
PMID: 30338661
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Computed Tomography Colonography vs Colonoscopy for Colorectal Cancer Surveillance After Surgery.
Authors: Weinberg D.S. , Pickhardt P.J. , Bruining D.H. , Edwards K. , Fletcher J.G. , Gollub M.J. , Keenan E.M. , Kupfer S.S. , Li T. , Lubner S.J. , et al. .
Source: Gastroenterology, 2017-11-22 00:00:00.0; , .
EPub date: 2017-11-22 00:00:00.0.
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Authors: Pickhardt P.J. , Edwards K. , Bruining D.H. , Gollub M. , Kupfer S. , Lubner S.J. , Kim D.H. , Ross E. , Keenan E. , Weinberg D.S. .
Source: Diseases Of The Colon And Rectum, 2017 Nov; 60(11), p. 1162-1167.
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Emerging stool-based and blood-based non-invasive DNA tests for colorectal cancer screening: the importance of cancer prevention in addition to cancer detection.
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Colorectal carcinoma: what should the oncologist recommend for screening?
Authors: Pickhardt P.J. .
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CT colonography for population screening: ready for prime time?
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Recent developments in colorectal imaging.
Authors: Pickhardt P.J. .
Source: Current Opinion In Gastroenterology, 2015 Jan; 31(1), p. 76-80.
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Volumetric texture features from higher-order images for diagnosis of colon lesions via CT colonography.
Authors: Song B. , Zhang G. , Lu H. , Wang H. , Zhu W. , J Pickhardt P. , Liang Z. .
Source: International Journal Of Computer Assisted Radiology And Surgery, 2014 Nov; 9(6), p. 1021-31.
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Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history.
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Source: The Lancet. Oncology, 2013 Jul; 14(8), p. 711-20.
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Computed tomography colonography: emerging evidence to further support clinical effectiveness.
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CT colonography: pitfalls in interpretation.
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