Abnormal Fecal Immunochemical Test Result Research Articles

Mo1642 – Patients are Often Unaware of Abnormal Fecal Immunochemical Test Results and Report Several Barriers to Colonoscopic Follow-Up

Mo1642 – Patients are Often Unaware of Abnormal Fecal Immunochemical Test Results and Report Several Barriers to Colonoscopic Follow-Up

Effect of Colonoscopy Outreach vs Fecal Immunochemical Test Outreach on Colorectal Cancer Screening Completion

Mailed fecal immunochemical test (FIT) outreach is more effective than colonoscopy outreach for increasing 1-time colorectal cancer (CRC) screening, but long-term effectiveness may need repeat testing and timely follow-up for abnormal results. Compare the effectiveness of FIT outreach and colonoscopy outreach to increase completion of the CRC screening process (screening initiation and follow-up) within 3 years. Pragmatic randomized clinical trial from March 2013 to July 2016 among 5999 participants aged 50 to 64 years who were receiving primary care in Parkland Health and Hospital System and were not up to date with CRC screenings. Random assignment to mailed FIT outreach (n = 2400), mailed colonoscopy outreach (n = 2400), or usual care with clinic-based screening (n = 1199). Outreach included processes to promote repeat annual testing for individuals in the FIT outreach group with normal results and completion of diagnostic and screening colonoscopy for those with an abnormal FIT result or assigned to colonoscopy outreach. Primary outcome was screening process completion, defined as adherence to colonoscopy completion, annual testing for a normal FIT result, diagnostic colonoscopy for an abnormal FIT result, or treatment evaluation if CRC was detected. Secondary outcomes included detection of any adenoma or advanced neoplasia (including CRC) and screening-related harms (including bleeding or perforation). All 5999 participants (median age, 56 years; women, 61.9%) were included in the intention-to-screen analyses. Screening process completion was 38.4% in the colonoscopy outreach group, 28.0% in the FIT outreach group, and 10.7% in the usual care group. Compared with the usual care group, between-group differences for completion were higher for both outreach groups (27.7% [95% CI, 25.1% to 30.4%] for the colonoscopy outreach group; 17.3% [95% CI, 14.8% to 19.8%] for FIT outreach group), and highest in the colonoscopy outreach group (10.4% [95% CI, 7.8% to 13.1%] for the colonoscopy outreach group vs FIT outreach group; P < .001 for all comparisons). Compared with usual care, the between-group differences in adenoma and advanced neoplasia detection rates were higher for both outreach groups (colonoscopy outreach group: 10.3% [95% CI, 9.5% to 12.1%] for adenoma and 3.1% [95% CI, 2.0% to 4.1%] for advanced neoplasia, P < .001 for both comparisons; FIT outreach group: 1.3% [95% CI, -0.1% to 2.8%] for adenoma and 0.7% [95% CI, -0.2% to 1.6%] for advanced neoplasia, P < .08 and P < .13, respectively), and highest in the colonoscopy outreach group (colonoscopy outreach group vs FIT outreach group: 9.0% [95% CI, 7.3% to 10.7%] for adenoma and 2.4% [95% CI, 1.3% to 3.3%] for advanced neoplasia, P < .001 for both comparisons). There were no screening-related harms in any groups. Among persons aged 50 to 64 years receiving primary care at a safety-net institution, mailed outreach invitations offering FIT or colonoscopy compared with usual care increased the proportion completing CRC screening process within 3 years. The rate of screening process completion was higher with colonoscopy than FIT outreach. clinicaltrials.gov Identifier: NCT01710215.

Abstract A25: A culturally-linguistically salient intervention to increase fecal immunochemical test uptake among Spanish-preferring Latino adults receiving care in community-based clinics

Abstract Background: Among Latinos in the US, colorectal cancer (CRC) is the third leading cause of cancer-related deaths. Despite the benefits of colorectal cancer screening (CRCS) being well recognized, screening is underutilized among Latino adults, ages 50-75. The availability of language and literacy appropriate educational information paired with an accessible, easy-to-use screening tool, such as fecal immunochemical test (FIT), within community health settings is a promising way to impact cancer-related disparities for Spanish-preferring Latino older adults. Formative qualitative efforts (focus groups, key informant interviews, and learner verification interviews) produced a culturally, and linguistically salient photonovella booklet and DVD titled, Latinos Colorectal Cancer Awareness, Research, Education and Screening (CARES). Purpose: This pilot study compared the efficacy of two intervention conditions on FIT uptake among Spanish-preferring Latino adults receiving care in community clinics. Participants were randomized to receive either the Latinos CARES intervention + FIT or CDC Brochure + FIT. We report preliminary findings at 6 months. Methods: Participants (N=76) were Latinos, accessing care at community-based clinics, prefer to receive their health information in Spanish, aged 50-75, at average CRC risk, and non-adherent to CRCS guidelines. Consented participants were administered a baseline interview assessing awareness of CRCS tests, preventive health model constructs, health literacy (consisting of two validated items), eHealth literacy (eHEALS), and sociodemographic variables. Following the baseline questionnaire, participants were randomized (1:1 allocation) to receive Latinos CARES intervention + FIT or CDC Brochure + FIT. The primary outcome was FIT kit screening uptake at 6 months. Results: Participants were mostly female (67.8%), median age of 55, with less than a High school diploma (61.8%), annual income of less than $10,000 (48.7%), no medical insurance (75.0%), were unemployed or retired (45.3%), self-identified as “other” for race (67.1%), and born in a country other than the US (93.4%). For those born outside the US, the mean number of years spent in the US was 23.4 years. No significant differences on baseline characteristics were found between study conditions. Accrual rate was an average 11 participants per month for 7 months. To date, FIT uptake is 87% (for both groups), a rate that exceeds the Healthy People 2020 goal of 70.5%. One participant with abnormal FIT results was referred for a colonoscopy. Results of participant's colonoscopy indicated cancer was not present. Conclusions: Providing educational materials (print and/or video), coupled with a FIT kit to Spanish-preferring Latinos receiving care in community clinics may be a promising strategy to bolster CRC screening uptake. The successful accrual rate is reflective of a high interest for education on CRCS among Spanish-preferring Latinos. Three-month follow-up for post-intervention assessments on awareness of CRCS tests, preventive health model constructs, and intervention use is currently underway, and assessment of intervention group differences is pending. Although preliminary, the high overall screening uptake among both study conditions far exceeds national targets and provides evidence to move to a larger scale RCT. Citation Format: Enmanuel Antonio Chavarria, Rania Abdulla, Liliana Gutierrez, Lynne Klasko, Dinorah Martinez Tyson, Claudia Aguado Loi, Julian Sanchez, Cathy Meade, Clement Gwede. A culturally-linguistically salient intervention to increase fecal immunochemical test uptake among Spanish-preferring Latino adults receiving care in community-based clinics. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A25.

Inadequate Utilization of Diagnostic Colonoscopy Following Abnormal FIT Results in an Integrated Safety-Net System.

The effectiveness of stool-based colorectal cancer (CRC) screening is contingent on colonoscopy completion in patients with an abnormal fecal immunochemical test (FIT). Understanding system and patient factors affecting follow-up of abnormal screening tests is essential to optimize care for high-risk cohorts. This retrospective cohort study was conducted in an integrated safety-net system comprised of 11 primary-care clinics and one Gastroenterology referral unit and included patients 50-75 years, with a positive FIT between April 2012 and February 2015. Of the 2,238 patients identified, 1,245 (55.6%) completed their colonoscopy within 1-year of the positive FIT. The median time from positive FIT to colonoscopy was 184 days (interquartile range 140-232). Of the 13% of FIT positive patients not referred to gastroenterology, 49% lacked documentation addressing their abnormal result or counseling on the increased risk of CRC. Of the patients referred but who missed their appointments, 62% lacked documentation following up on the abnormal result in the absence of a completed colonoscopy. FIT positive patients never referred to gastroenterology or who missed their appointment after referrals were more likely to have comorbid conditions and documented illicit substance use compared with patients who completed a colonoscopy. Despite access to colonoscopy and a shared electronic health record system, colonoscopy completion after an abnormal FIT is inadequate within this safety-net system. Inadequate follow-up is in part explained by inappropriate screening, but there is an absence of clear documentation and systematic workflow within both primary care and GI specialty care addressing abnormal FIT results.