N08 Awareness of Inflammatory Bowel Disease-associated Colorectal Cancer risk and its management in patients with Inflammatory Bowel Disease: a systematic review

Abstract

Abstract Background Inflammatory bowel disease (IBD) increases the risk of colorectal cancer (CRC). Although literature exists on patients’ general IBD knowledge, little is known about IBD patients’ awareness of CRC risk. This systematic review aimed to explore the literature on IBD patients’ knowledge, attitudes, and awareness of CRC risk and its management. Methods Medline, EMBASE, and PubMed databases were searched from inception to November 2023. All study designs and publication types were included. Non-English articles and those assessing general IBD knowledge were excluded. Cochrane’s ‘checklist of items to consider in data extraction’ was adapted for data extraction and the appraisal tool for cross-sectional studies (AXIS) was used to appraise the quality of included studies. All data relevant to the review question were extracted from the included studies and were thematically analysed for main themes. Results Twenty-three studies (17 full papers and 6 conference abstracts), including 4674 participants (2481 Ulcerative Colitis, 53.5% females) were included (PRISMA diagram Figure 1). The quality of included studies ranged from moderate to low. Overall, 18 studies reported CRC risk knowledge, 3 studies reported patients’ knowledge of CRC symptoms and risk factors, 7 reported attitudes towards cancer screening and 8 reported patient knowledge or attitude towards colectomy for dysplasia. The review found that IBD patients were moderately aware of the CRC risk, poorly aware of the symptoms and risk factors for CRC, and moderately feared this complication of IBD. Most overestimated their own risk of CRC and wanted more discussion with health professionals. Although the role of colonoscopy in cancer screening and diagnosis was well known, patients expressed mixed attitudes towards it due to the unpleasantness of bowel preparation, discomfort, or fear of colonoscopy complications. Low awareness of screening initiation time and varied willingness to undergo colectomy for dysplasia, irrespective of the extent of risk, was reported. Surgery was reported to be a last resort. Conclusion Limited literature exists on IBD patients’ awareness of CRC risk and its management to confidently infer the level of awareness and extent of educational needs of IBD patients. More research is needed to establish patients’ understanding of CRC risk and to optimise management.