Abstract
BackgroundTimely follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. This study evaluates the effectiveness of two ongoing interventions designed to improve colonoscopy uptake after a positive fecal occult blood test (FOBT) result within Ontario’s population-wide ColonCancerCheck program. The first was a revision of mailed FOBT lab results to physicians to explicitly define a positive FOBT and to recommend colonoscopy. The second was a letter to participants informing them of the positive FOBT and urging them to seek appropriate follow-up.MethodsProspective cohort study using Ontario’s ColonCancerCheck program data sets (2008–2011), linked to provincial administrative health databases. Crude rate ratios were calculated to assess determinants of colonoscopy uptake among an Ontario-wide FOBT-positive cohort with rolling enrolment, followed from October 2008 through February 2011. Segmented time-series regression was used to assess the average additional change in colonoscopy uptake after FOBT-positive status following the introduction of two ongoing interventions among the same cohort.ResultsA notification mailed directly to FOBT-positive screening participants was observed to increase colonoscopy uptake, beyond the modest average underlying increase throughout the study period, by an average of 3% per month (multivariable-adjusted RR: 1.03, 95% CI: 1.00–1.06). However, revision of the existing FOBT result notification to physicians was observed to have no effect.ConclusionsDirect participant notification of a positive FOBT result improved adherence with follow-up colonoscopy in Ontario’s population-wide ColonCancerCheck program. Further participant-directed interventions may be effective means of maximizing adherence in population-wide screening.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0226-0) contains supplementary material, which is available to authorized users.
Highlights
In their lifetime, 1 in 13 men and 1 in 15 women are expected to develop colorectal cancer, the second and third most common cause of cancer mortality for Canadians, respectively [1]
The second was a letter (Additional file 1) mailed directly to participants informing them of a positive fecal occult blood test (FOBT) result and urging them to contact a primary care physicians (PCP) or nurse practitioner to discuss appropriate diagnostic follow-up
The proportion of person-time contribution prior to strategy 1, between strategy 1 and 2, and poststrategy 2 was 50.2, 27.7, and 22.1 persons-months, respectively, while 46.3%, 28.0%, and 25.7% of colonoscopy service dates fell within these respective intervals
Summary
1 in 13 men and 1 in 15 women are expected to develop colorectal cancer, the second and third most common cause of cancer mortality for Canadians, respectively [1]. Diagnostic colonoscopy after a positive fecal occult blood test (FOBT) is essential for FOBT-derived colorectal cancer mortality reduction. Canadian provinces have begun to implement populationwide fecal occult blood screening programs, the first being Ontario’s ongoing ColonCancerCheck (CCC), implemented in April 2008 [4] by Cancer Care Ontario (CCO). The CCC Program provides biennial screening with guaiac FOBT kits (Hemoccult-II), distributed primarily by primary care physicians (PCP), for average-risk individuals between the ages of 50 and 74 years, inclusive, and recommends follow-up of a positive result with colonoscopy. Follow-up of fecal occult blood screening with colonoscopy is essential for achieving colorectal cancer mortality reduction. This study evaluates the effectiveness of two ongoing interventions designed to improve colonoscopy uptake after a positive fecal occult blood test (FOBT) result within Ontario’s population-wide ColonCancerCheck program. The second was a letter to participants informing them of the positive FOBT and urging them to seek appropriate follow-up
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