Rachel B. Issaka’s research while affiliated with Gabrail Cancer Center and other places

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Publications (83)


S547 Decreasing Patient Fear of Colonoscopy After an Abnormal Fecal Immunochemical Test: Results from a Pilot Video Decision Aid
  • Article

October 2024

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1 Read

The American Journal of Gastroenterology

Talor Hopkins

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Ari Bell-Brown

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Pedro Martinez-Pinto

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[...]

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Rachel B. Issaka




Clinician perceptions on barriers and facilitators to 1‐year surveillance colonoscopy completion in survivors of colorectal cancer
  • Article
  • Full-text available

September 2024

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33 Reads

Introduction Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Surveillance colonoscopy is recommended 1‐year after surgical resection for patients with stage I‐III CRC; however, only 18%–61% of CRC survivors complete this test. This study describes clinician‐identified barriers and facilitators to surveillance colonoscopy among CRC survivors. Methods We conducted semi‐structured interviews with clinicians until thematic saturation was achieved. Interviews were analyzed using the social cognitive theory. Results Thirteen clinicians were interviewed, and all identified health system‐level barriers to surveillance colonoscopy completion; the most common being fragmented care due to patients receiving care across many health systems. Clinicians also identified social determinants of health barriers (e.g., geographical distance between patients and health systems) to 1‐year surveillance colonoscopy completion. Conclusions Clinicians identified several potentially modifiable barriers to 1‐year surveillance colonoscopy completion which, if addressed, could improve post‐treatment care and outcomes among stage I‐III CRC survivors.

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NCCN Guidelines® Insights: Colorectal Cancer Screening, Version 1.2024: Featured Updates to the NCCN Guidelines

September 2024

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27 Reads

Journal of the National Comprehensive Cancer Network: JNCCN

The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel’s recommendations regarding the age at which to initiate screening in average-risk individuals and those with increased risk based on personal history of childhood, adolescent, and young adult cancer.


Figure 1. Consort diagram of included and excluded patients. CRC, colorectal cancer, FIT, fecal immunochemical test; NCQA, National Commission on Quality Assurance; UW, University of Washington. a Excluded before postcard mailings. b Excluded after postcard mailings.
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Multivariate logistic regression of characteristics associated with FIT completion after mailed FIT outreach
Factors associated with mailed fecal immunochemical test (FIT) completion in an integrated academic-community healthcare system

August 2024

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2 Reads

Clinical and Translational Gastroenterology

Introduction Mailed fecal immunochemical test (FIT) outreach is an effective strategy to increase colorectal cancer (CRC) screening. This study aimed to determine the patient-, clinic-, and geographical-level factors associated with CRC screening completion in a mailed FIT outreach program. Methods This retrospective cohort study was conducted in UW Medicine’s integrated healthcare system, and included patients 50-75 years old, who were due for CRC screening, and had a primary care encounter in the past 3 years. Eligible patients received mailed outreach that included a letter with information about CRC screening, FIT kit, and a pre-paid return envelope. CRC screening and factors associated with completion were obtained from electronic health records and the CRC screening program database. Results Of the 9,719 patients who received mailed outreach, 29.6% completed FIT mailed outreach. The median FIT return time was 27 days (IQR 14 – 54). On multivariate analysis, individuals with a higher area deprivation index, insured through Medicaid, living without a partner, and whose last primary care visit was >12 months ago were less likely to complete a FIT compared to their counterparts. Over a 12-month period, overall CRC screening across the health system increased by 2 percentage points (68% to 70%). Discussion Mailed FIT outreach in an integrated academic-community practice was feasible, with 32% of invited patients completing CRC screening by FIT or colonoscopy, on par with published literature. Patient and geographic-level factors were associated with CRC screening completion. These data will inform additional interventions aimed to increase CRC screening participation in this population.


Study eligibility flow diagram. CRC indicates colorectal cancer; NH, non‐Hispanic; LIS, local isolation score.
Association between racial residential segregation and screening uptake for colorectal and cervical cancer among Black and White patients in five US health care systems

Background Despite increased recognition that structural racism contributes to poorer health outcomes for racial and ethnic minorities, there are knowledge gaps about how current patterns of racial residential segregation are associated with cancer screening uptake. The authors examined associations between Black residential segregation and screening for colorectal cancer (CRC) and cervical cancer among non‐Hispanic Black and non‐Hispanic White adults. Methods This was a retrospective study of CRC and cervical cancer screening‐eligible adults from five health care systems within the Population‐Based Research to Optimize the Screening Process (PROSPR II) Consortium (cohort entry, 2010–2012). Residential segregation was measured using site‐specific quartiles of the Black local isolation score (LIS). The outcome was receipt of CRC or cervical cancer screening within 3 years of cohort entry (2010–2015). Logistic regression was used to calculate associations between the LIS and screening completion, adjusting for patient‐level covariates. Results Among CRC (n = 642,661) and cervical cancer (n = 163,340) screening‐eligible patients, 456,526 (71.0%) and 106,124 (65.0%), respectively, received screening. Across PROSPR sites, living in neighborhoods with higher LIS tended to be associated with lower odds of CRC screening (Kaiser Permanente Northern California: adjusted odds ratio [aOR] LIS trend in Black patients, 0.95 [p < .001]; aOR LIS trend in White patients, 0.98 [p < .001]; Kaiser Permanente Southern California: aOR LIS trend in Black patients, 0.98 [p = .026]; aOR LIS trend in White patients, 1.01 [p = .023]; Kaiser Permanente Washington: aOR LIS trend in White patients, 0.97 [p = .002]. However, for cervical cancer screening, associations with the LIS varied by site and race (Kaiser Permanente Washington: aOR LIS trend in White patients, 0.95 [p < .001]; Mass General Brigham: aOR LIS trend in Black patients, 1.12 [p < .001]; aOR LIS trend in White patients, 1.03 [p < .001]). Conclusions Across five diverse health care systems, the direction of the association between Black residential segregation and screening varied by PROSPR site, race, and screening type. Additional research, including studies that examine multiple dimensions of segregation and structural racism using intersectional approaches, are needed to further disentangle these relationships.




Citations (43)


... The reported specificity of these tests is 90.6% for advanced neoplasms (advanced adenoma and CRC combined) and 86.9% for any neoplasm [1,2]. The bloodbased circulating tumor DNA (ctDNA) test, which uses circulating cell-free DNA (cf-DNA) as a biomarker, demonstrated an overall sensitivity of 83.1% for CRC and 13.2% for advanced adenoma, with a specificity of 89.6% for advanced neoplasms in the screening population [3]. ...

Reference:

Adopting Non-invasive Approaches into Precision Colorectal Cancer Screening
A Cell-free DNA Blood-Based Test for Colorectal Cancer Screening
  • Citing Article
  • March 2024

The New-England Medical Review and Journal

... Patients previously diagnosed with CRC, any metastatic cancer, inflammatory bowel diseases, myocardial infarction within 6 months, congestive heart failure, ischemic vascular disease, or chronic obstructive pulmonary disease within the last year were excluded. Other eligibility criteria are shown in Figure 1 and previously described in detail (14). ...

Implementing an Organized Colorectal Cancer Screening Program: Lessons Learned From an Academic–Community Practice

AJPM Focus

... In the current dataset, there were only a few differentially expressed targets when comparing adenoma patients to either control or cancer patients, none of which appeared to have strong potential as biomarkers. The limited ability to detect advanced precursor lesions from blood plasma liquid biopsies has also been noted for cell-free DNA as well [29]. ...

913e CLINICAL VALIDATION OF A CELL-FREE DNA BLOOD-BASED TEST FOR COLORECTAL CANCER SCREENING IN AN AVERAGE RISK POPULATION
  • Citing Article
  • May 2023

... We also identified patientlevel and geographic-level factors that were associated with increased odds of CRC screening. Our health system is already incorporating the findings from the first year of outreach to optimize the screening program (e.g., increased use of navigation to colonoscopy) and piloting new interventions to improve followup colonoscopy for patients with abnormal FIT results (36). Mailed outreach presents an opportunity to engage populations that might not otherwise present to primary care to discuss CRC screening. ...

Health System–Provided Rideshare Is Safe and Addresses Barriers to Colonoscopy Completion
  • Citing Article
  • October 2023

Clinical Gastroenterology and Hepatology

... Current recommendations advocate colonoscopy screening for colon cancer in adults aged 45 years and older with an average lifetime risk. 9 However, according to a US Department of Health and Human Services survey, only 64.8% of adults older than 40 years undergo ageappropriate screening. 10 Our patient did not undergo screening colonoscopy until the age of 70. ...

AGA Clinical Practice Update on Risk Stratification for Colorectal Cancer Screening and Post-Polypectomy Surveillance: Expert Review
  • Citing Article
  • September 2023

Gastroenterology

... They are optimally placed to identify and address drug related problems, and can improve the availability and efficiency of healthcare. (18,19) Overseas model where pharmacists are integral member of the multi-disciplinary primary care teams has demonstrated extended roles in many direct patient care activities, including but not limited to medication management, (18,20) vaccination, (21) disease screening, (22,23) and pharmacist prescribing. (24) Primary healthcare blueprint by HKSAR Government clearly indicated the uniqueness of pharmacy services in primary care. ...

Primary care provider perspectives on the role of community pharmacy in colorectal cancer screening: a qualitative study

BMC Health Services Research

... Integrating the vast array of patient data to assess disease risk represents a significant challenge in modern medicine, particularly as screening is typically conducted by general practitioners who must possess a broad knowledge base across a wide range of diseases, each with its own set of unique risk factors. Machine learning (ML) algorithms present a promising solution to this challenge, especially for HCC, and could further reduce healthcare disparities, if developed cautiously 10 . Several studies have shown the superiority of ML algorithms over traditional regression analyses or few-parameter based decision-support systems as implemented in current guidelines 1,[11][12][13][14][15][16][17] . ...

Addressing racial and ethnic disparities in US liver cancer care
  • Citing Article
  • June 2023

Hepatology Communications

... 8,9 Our prior analysis found that older age, higher stage CRC, and living without a partner were associated with lower adherence to surveillance colonoscopy. 10 Other factors such as distance from an endoscopy suite also impact adherence. 11 Many demographic and clinical factors identified to date are non-modifiable, and administrative claims data may not completely capture intervenable factors. ...

Association between patient, clinic, and geographical-level factors and 1-year surveillance colonoscopy adherence

Clinical and Translational Gastroenterology

... Further, in their scoping review of tools to measure institutional and structural racism in GI, Liu et al. [2023] (69) found that studies primarily defined groups using residential racial segregation. They found that more segregation was associated with poorer health outcomes for racial and ethnic minority groups and found the most robust evidence in GI cancer incidence, screening and outcomes. ...

Tools to Measure the Impact of Structural Racism and Discrimination on Gastrointestinal and Hepatology Disease Outcomes: A Scoping Review
  • Citing Article
  • December 2022

Clinical Gastroenterology and Hepatology

... First, the response rate of 7.7% is low but is consistent with other studies distributed through large email contact lists without incentives for participation. [41,42] In addition, the representativeness of our sample size is limited by a lack of gender diversity, with no respondents reporting that they are nonbinary, as well as an overrepresentation of female and White respondents. Furthermore, several of our findings may be reflective of medical training more broadly and may not be unique to hepatology. ...

Diversity, Equity, and Inclusion in Gastroenterology and Hepatology: A Survey of Where We Stand

Gastroenterology