S324 Positive Fecal Immunochemical Testing (+FIT) in the COVID-19 Pandemic: Resilient Systems in Troubled Times

Abstract

Introduction: Colorectal cancer screening via colonoscopy decreased significantly due to the COVID-19 pandemic, with mail-out fecal immunochemical testing (FIT) initiated to maintain screening. Due to concerns surrounding +FIT follow-up we added FIT navigation (FITNav) via a nurse practitioner who followed +FIT to colonoscopy in August 2020. After implementation we noted little improvement in colonoscopy < 180 days compliance. This prompted a quality improvement (QI) project which resulted in a centralized database. Here we report a subgroup analysis to answer the question: were there racial disparities in +FIT follow-up prior to FITNav implementation? Methods: We queried +FIT from patients 45-85 y/o from 3/1/2019/20-9/3/2019/20, defined as the pre-pandemic and pandemic cohorts respectively. Patients with dementia & >65 y/o, diagnostic/inpatient FIT, or provider-initiated cancellation of colonoscopy due to comorbidities were excluded. Chart review retrieved FIT indications, patient/navigator notification time, GI consult placement time, and colonoscopy. We added Area deprivation index (ADI) to evaluate neighborhood-level disparities. An adjusted and unadjusted cox regression model was used to evaluate colonoscopy < 180 days between pandemic/pre-pandemic, summarizing via hazard ratios (HR) and 95% confidence intervals (CI). (Figure) Results: There were 121 & 103 +FIT meeting criteria in the pandemic & pre-pandemic respectively. Demographics (age, marital status, race, ADI, and sex) between periods showed no statistically significant differences. Proportion receiving colonoscopy < 180 days in the pre-pandemic and pandemic periods was 53.7% and 60.2% (unadjusted HR 1.08, 95% CI 0.76-1.54, p=0.676). This remained insignificant when adjusted for race/ethnicity, marital status, priority group, ADI, time to notification, and age (adjusted HR 1.03, 95% CI 0.71-1.50, p=0.872). While Black, non-Hispanic individuals had a univariate HR of 2.09 (95% CI 1.33-3.29 p=0.001), multivariate HR was 1.59 (95% CI 0.92-2.74, p=0.093). ADI did not show a statistically significant difference upon univariate or multivariate analysis. (Table) Conclusion: No findings were present which suggested new or exacerbated racial disparities. Additionally, neighborhood-level disparities did not modify these findings; however, this evaluation is limited by sample size.Figure 1.: Kaplan-Meier Plot Colonoscopy in <180 days Pre-pandemic vs. Pandemic y-axis= Probability Blue= Pre-pandemic Red= Pandemic Table 1. - Hazard Ratios Obtained on Cox Regression for Pre-pandemic/Pandemic Cohorts Total HR (univariable)* HR (multivariable)* Cohort Pre-pandemic 114 (53%) Pandemic 101 (47%) 1.08 (0.76-1.54, p=0.676) 1.03 (0.71-1.50, p=0.872) Race/Ethnicity Caucasian/ Non-Hispanic 162 (75%) Black/ Non-Hispanic 26 (12%) 2.09 (1.33-3.29, p=0.001) 1.59 (0.92-2.74, p=0.093) Hispanic 15 (7%) 0.80 (0.37-1.73, p=0.573) 0.74 (0.33-1.64, p=0.454) Others 6 (4%) 0.74 (0.33-1.64, p=0.454) 0.82 (0.25-2.67, p=0.741) Declined/Unknown 6 (4%) 0.55 (0.13-2.22, p=0.398) 0.47 (0.11-1.98, p=0.304) Marital Status Married 113 (52.6%) Not Married 102 (47.4%) 0.68 (0.47-0.97, p=0.033) 0.74 (0.51-1.10, p=0.136) ADI National Rank Mean (SD) 64.1 (22.7) 0.99 (0.99-1.00, p=0.127) 1.00 (0.99-1.01, p=0.441) Days to FIT Notification Mean (SD) 9.0 (12.7) 0.98 (0.96-1.01, p=0.141) 0.98 (0.95-1.01, p=0.131) Age Mean (SD) 66.4 (8.4) 0.98 (0.96-1.00, p=0.035) 0.98 (0.96-1.01, p=0.133) *Blank Cells represent reference groups.