How Cleveland Clinic’s Gastrointestinal Cancer Program Is Working to Reshape Screening, Care and Outcomes

A fundamental principle in cancer prevention and screening is that timing is everything. With gastrointestinal cancer, this is especially true, as five-year survival rates typically exceed 90% when caught early. However, early diagnoses can be challenging — patients are often asymptomatic, tumor growth is slow and a lack of routine screening in Western countries represent some of the biggest challenges.

To help overcome these challenges, Cleveland Clinic established the Early Gastrointestinal Cancer Program to improve screening, education and research.

“I think there are several opportunities to improve the lives of our patients with gastrointestinal cancer,” says Michelle Kang Kim, MD, PhD, AGAF, FASGE, Chair of the Department of Gastroenterology, Hepatology and Nutrition, at Cleveland Clinic and the Director of the Early Gastrointestinal Cancer Program. “In my eyes, the best way to improve outcomes is to detect cancer early. Luckily, with GI cancer, there are ways to do this. We felt like this program was a really great opportunity to not do it just for one cancer, but to do it across all cancers, particularly in the GI tract.”

While the program is still new, Dr. Kim says the group has already laid the groundwork for some of their objectives. Along with improved outreach, they are looking at ways to implement scalable screening initiatives to increase access and detect cancer earlier. Simultaneously, improving patient adherence to screening tests and follow-ups is another priority for the program.

Efforts to improve screening

Dr. Kim notes that while two-thirds of patients in the U.S. eligible for colon cancer screening are being screened, that still means one-third of eligible patients are not.

“I find it really astounding that we have great doctors, and we have great ways to screen with stool tests and with colonoscopies, but in general, one out of three people in this country is not being screened,” says Dr. Kim. “Oftentimes in certain populations, it's actually more than that. But there are a lot of things that we can do to treat gastrointestinal cancer, pancreatic cancer, liver cancer and esophageal cancer. So that's why we feel it's so important for people to understand their risk factors and understand screening eligibility.”

Dr. Kim adds that one of the distinguishing factors of the program is that it focuses on all forms of GI cancer rather than just one specific type. The hope is that by being more encompassing, the program can have a greater impact on GI cancer prevention and control.

“We believe this program is a first-of-its-kind by offering cancer screening and care across an entire spectrum like this,” she explains. “That's where we think we can offer something special in terms of clinical care, education, research and innovation.

A focus on discovery

In terms of research, the group already has several projects underway, including:

• Dr. Kim is leading a study funded by an NIH grant to look at how AI can be used to identify risk factors and detect gastrointestinal cancer earlier. The group hopes to expand to other GI cancers in the future.
• Cleveland Clinic’s GI behavioral health specialists, led by Stephen Lupe, PsyD, are working on a project that can identify patient profiles and preferences for outreach regarding screening adherence. They hope to improve clinician-patient communication and improve screening follow-through rates.
• A separate research project is being conducted to analyze why certain patients are overdue for screening and what actions can be implemented to improve adherence.
• Ongoing efforts are being made to develop biomarker-based translational studies that could further improve GI cancer screening and early detection.
• Clinicians are looking at ways to expand stool-based screening usage with average- and high-risk patients.

Cleveland Clinic’s global presence also enhances the program’s research efforts. The group recognizes that treating patients worldwide can provide unique and valuable insights.

“There's a lot of opportunity with Cleveland Clinic having locations in Florida, London and Abu Dhabi,” says Dr. Kim. “Our specialists care for patients from such different walks of life and such different populations. It really helps to inform what you're doing in a very generalizable sense, so that we’re looking beyond what is applicable to Northeast Ohio.”

Next steps

Presently, the Early Gastrointetinal Cancer Program is largely focused on patient education and provider-side improvements. Community outreach events and partnerships are also planned.

Dr. Kim says she’d like to see the program take advantage of the distinct resources available at Cleveland Clinic, including laboratory science teams, community outreach teams and clinicians in the Sanford R. Weiss, MD, Center for Hereditary Colorectal Neoplasia.

“This is still a new program, but we’re excited by both what we’ve already been able to accomplish as well as the potential impact we believe we can have down the road,” says Dr. Kim. “We’re still working on building the program up —we’re in the process of bringing on a director for the program — but I think this is a unique program and a unique opportunity to improve screening, education and patient care when it comes to preventing and controlling GI cancers.”