Colorectal Cancer Screening Compliance Research Articles

Cancer History and Social Support Impact Colorectal Cancer Screening Utilization by Race/Ethnicity.

This study examined the association between cancer history, social support, and up to date colorectal cancer (CRC) screening among four racial/ethnic groups. We conducted a cross-sectional analysis using data on respondents aged 45-75 years from the 2022 Behavioral Risk Factor Surveillance System. Our outcome of interest was CRC screening and exposures of interest were race/ethnicity, cancer history, and social support. Weighted multivariable logistic regression was performed. Among 73,869 adults, the CRC screening rate was 66.8% with the highest rate in non-Hispanic (NH) Whites (72.2%) and the lowest in Hispanics (52.6%). Screening rates were higher in adults with a cancer history (81.9%) and those having social support (69%). Hispanic adults with a cancer history had lower screening use (50.9% vs. 77.4% in no cancer history group; p-value <0.001). Regardless of race/ethnicity, adults without social support had lower screening utilization (p-value<0.05). In effect modification, NH White adults who reported no cancer history and lack of social support were 12% less likely to have CRC screening than those with social support but without cancer history (OR,0.88;95% CI, 0.79-0.98). Similar results were observed among Hispanic adults without a cancer history and social support, with 37% less likely to have CRC screening than those with social support but no cancer history (OR,0.63;95% CI, 0.42-0.93). NH White and Hispanic adults without a cancer history and limited social support were less likely to have CRC screening uptake. By implementing culturally tailored interventions that address social support needs, greater CRC screening compliance may be increased among these populations.

Trends in colorectal cancer screening compliance and incidence among 60- to 74-year-olds in China.

Compliance with colonoscopy among elderly individuals participating in colorectal cancer (CRC) screening programs is unsatisfactory, despite a high detection rate of bowel-related diseases. In this study, our aim was to analyze the impact of risk factors on the trends of compliance and detection rates in colonoscopy among high-risk individuals aged 60-74. A retrospective study was conducted on the high-risk individuals aged 60-74 participating in the 2021 CRC screening program in Tianjin, China. Logistic regression analyses, including both univariate and multivariate analyses, were performed to explore the impact of different risk factors on colonoscopy compliance among the high-risk individuals. Besides, the study investigated the influence of various risk factors on the detection rates of bowel-related diseases among the high-risk individuals who underwent colonoscopy. A total of 24,064 high-risk individuals were included, and 5478 individuals received a free colonoscopy, with an overall compliance of 22.76%. Among them, the adenoma detection rate was 55.46%. Males and individuals with a positive FIT had high compliance and detection rates for CRC, advanced adenomas (AA), advanced colorectal neoplasia (ACN), and colorectal neoplasm (CN). Individuals aged 70-74 were associated with low compliance but high CRC, ACN, and CN detection rates. Individuals who reported a history of chronic constipation, bloody mucous, and CRC in first-degree relative showed high compliance but no significantwere associated with the detection rates of CRC, AA, and CN. This study reported several risk factors associated with the screening behaviors for CRC. Patterns and trends in CRC, AA, ACN, and CN compliance and detection rates correlate with risk factors.

Exploring Gender Disparities in Factors Influencing Colorectal Cancer Screening Compliance in Singapore.

The uptake of colorectal cancer (CRC) screening remains suboptimal in Singapore. Existing research highlights gender-related disparities in screening behaviors. This study aims to evaluate the gender differences in factors associated with CRC screening compliance in Singapore, with a specific focus on cancer screening beliefs and knowledge on CRC screening guidelines. Data were collected from an online survey on cancer screening belief, knowledge, and practices in Singapore. Multivariate logistic regression analysis was conducted to identify independent factors associated with compliance in CRC screening. The study included 633 participants aged 50-69 years, eligible for CRC screening. Only 132 participants (20.9%) complied with CRC screening guidelines with no significant gender differences observed in compliance rates. Most participants held positive beliefs on routine screening (86.9%) and perceived screening benefits in improving treatment outcomes (89.6%) and reducing mortality rates (77.6%). However, both genders exhibited limited knowledge regarding CRC screening guidelines. Only 28.3% were aware that CRC screening should commence at age 50 years. While nearly half of participants knew FIT (44.7%) and colonoscopy (52.0%) as CRC screening modalities, only 27.5% and 15.2% recognized the recommended intervals for FIT and colonoscopy screening respectively. Multivariate analysis revealed a positive association between knowledge on CRC screening guidelines and CRC screening compliance for both genders. Gender-specific variations were observed in the factors associated with CRC screening compliance. Specifically, women with a family history of cancer, believing in routine cancer screening, and prior adherence to breast cancer screening and men within the older cohort (55-69 years) were more likely to comply with CRC screening. Low compliance with CRC screening was observed in Singapore. Targeted interventions should address gender-specific factors and highlight CRC screening guidelines as a crucial component of cancer education for entire screening eligible population in order to improve CRC screening compliance.

Evaluation of Colorectal Cancer Screening Awareness and Compliance Rates over the Age of 40: Single Center Data in Türkiye

The frequency of colorectal cancer is increasing under the age of 50, and new sights have emerged regarding the initiation of screening in the earlier age group. This study aims to measure the consciousness of patients over the age of 40 about colorectal cancer screening and to reveal the screening rates of individuals over the age of 50. 300 consecutive patients who applied to our center and were older than 40 years of age were included. The questionnaire was created based on current guidelines and literature knowledge by the investigators and done through face-to-face interviews. Patients over 50 years of age who did not undergo screening were analyzed by dividing them into groups according to their socio-demographic characteristics and colorectal cancer risk factors. While 64.7% of the participants stated that they knew about colorectal cancer screening, only 32.4% of the participants aged 50 and over had colorectal cancer screening. The vast majority of patients stated that they did not have enough knowledge about the subject. The rate of participants who stated that they were considering entering the cancer screening program after completing this questionnaire was 73.7%. Colorectal cancer screening rates of non-smokers, women, and married participants were higher than the other group (P=0.016, P=0.017, and P=0.033, respectively). This study shows low screening compliance of individuals over the age of 50. We think that it is important to encourage and inform all adults over the age of 40 about colorectal cancer screening for public health.

Rates of Compliance in South Indian American Communities of Southern California Regarding Cancer Screening.

Studies have shown lower rates of cancer screening and high mortality rates among all Asian Americans than among non-Hispanic White populations. However, most of these studies often confound diverse Asian American subgroups with limited data on cancer screening for Indian Americans, with this group being particularly interesting because of their counterintuitive socioeconomic status. For this reason, the objective of this study is to evaluate knowledge of the United States Preventive Services Task Force (USPSTF) cancer screening guidelines and compliance among South Indian Americans residing in Southern California. This was a cross-sectional study gathering community responses through an electronic survey. The survey reports knowledge of USPSTF screening guidelines and participant compliance rates. Rates were further compared to non-Hispanic White populations from official sources. South Indian Americans residing in California had lower rates of compliance for colorectal, lung, and breast cancer screening when compared to that of non-Hispanic White populations in the same region, with the exception of cervical cancer screening rates. Understanding the cultural characteristics of special populations, such as Indian Americans, can help communities adhere to more effective screening practices that can improve outcomes.

Quantifying disease-interactions through co-occurrence matrices to predict early onset colorectal cancer

Colorectal cancer (CRC) is the third most common cancer in terms of the number of cases and deaths in men and women in the USA. According to the Centers for Disease Control and Prevention, the CRC screening compliance rate remains low in the United States. It is even more concerning that the number of cases and deaths due to CRC is increasing in the younger population, for which there is no guideline to get colonoscopy screening. In this paper, we develop a novel network-based model to identify patients under 50 years of age having a high risk of CRC, particularly those who do not have a family history. Our model can help predict which patients are at risk of developing colorectal cancer to aid the practicing primary care physician and gastroenterologist to triage patients into meaningful risk groups to provide accelerated diagnostic steps and care to these patients. The model uses our proposed variables created through comorbidity network matrices obtained from CRC and non-CRC patients as inputs. We used the electronic medical records of thousands of CRC and non-CRC patients to develop and validate the models. Our model for younger patients correctly predicted 73.2% of the patients with future diagnoses with an area under the ROC curve of 0.81. At the 50% sensitivity, the false positive rate was 11.5%. The performance of our model is the highest in the current state-of-the-art. Our proposed variables quantifying the interactions between multiple diseases can also be adapted in future predictions of other diseases in a patient.

N-myristoyltransferase 2-based Blood Test for the Detection of Colorectal Adenomatous Polyps and Cancer.

Colorectal cancer is the second leading cause of cancer-related deaths. This study demonstrates the utility of a simple blood test with high sensitivity and specificity for colorectal adenomatous polyps and cancer. A simple blood test with high sensitivity and specificity for adenomas would help identify individuals for a follow-up colonoscopy during which any adenomatous polyps found could be removed, thus preventing colorectal cancer (CRC). We determined the H-score by using immunohistochemical analyses of N-myristoyltransferase 2 (NMT2) in peripheral blood mononuclear cells (PBMC) isolated from the blood. We determined the sensitivity and specificity of the NMT2-based blood test in identifying colorectal adenomatous polyps and cancer. All experimental procedures were performed by research personnel blinded to the colonoscopy status of the participants. In this cohort study, participants were recruited from those coming for an outpatient colonoscopy at a referral center. PBMC were collected from 74 subjects at the Health Sciences Centre, Winnipeg, Canada. Samples were collected from colonoscopy patients prior to colonoscopy. All 74 subjects were included in CRC vs. non-CRC analysis, whereas only 70 subjects were analyzed for colorectal adenomatous polyps and cancer versus individuals with no evidence of disease and non-adenomatous polyps. NMT2 expression was tested in samples by immunohistochemistry. The expression of NMT2 was significantly higher in PBMC of subjects with colorectal adenomatous polyps and cancer (n = 34) compared with individuals with non-adenomatous polyps or no evidence of disease (n = 36) (P < 0.0001). The test had an overall sensitivity of 91% (95% confidence intervals: 84.49-97.80) and specificity of 81% (95% confidence intervals: 71.28-89.83) in detecting colorectal adenomatous polyps and cancer (all stages). Our results suggest that the sensitivity of NMT2 in detecting adenomatous polyps is high (91%). A simple blood-based CRC screening test using NMT2 expression detects colorectal adenomatous polyps and cancer with high sensitivity and specificity has the potential of increasing the compliance for CRC screening as has been reported for other blood-based CRC screening tests.

Promising Epigenetic Biomarkers for the Early Detection of Colorectal Cancer: A Systematic Review.

Simple SummaryHigh-performance, non-invasive screening is a requirement in colorectal cancer (CRC) as early detection is a key in reducing disease-related mortality in CRC patients. However, colonoscopy, the actual gold standard in CRC screening, is invasive and often avoided by patients. Conventional screening methods encounter several limitations; therefore, new testing strategies have been considered. DNA methylation is the most prevalent epigenetic alteration that occurs in all stages of carcinogenesis. Our research focused on identifying potential DNA methylation single biomarkers or panels as promising tools in the early detection of CRC; it evaluated methylated genes currently targeted by already approved diagnostic kits. A panel of five CTCF methylated binding sites holds the promise for early-stage specific detection of CRC. CRC screening compliance and accuracy can be enhanced by employing a stool mt-DNA methylation test.In CRC, screening compliance is decreased due to the experienced discomfort associated with colonoscopy, although this method is the gold standard in terms of sensitivity and specificity. Promoter DNA methylation (hypomethylation or hypermethylation) has been linked to all CRC stages. Study objectives: to systematically review the current knowledge on approved biomarkers, reveal new potential ones, and inspect tactics that can improve performance. This research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; the risk of bias was evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies criteria (QUADAS-2). The Web of Science® Core Collection, MEDLINE® and Scopus® databases were searched for original articles published in peer-reviewed journals with the specific keywords “colorectal cancer”, “early detection”, “early-stage colorectal cancer”, “epigenetics”, “biomarkers”, “DNA methylation biomarkers”, “stool or blood or tissue or biopsy”, “NDRG4”, “BMP3”, “SEPT9”, and “SDC2”. Based on eligibility criteria, 74 articles were accepted for analysis. mSDC2 and mSEPT9 were frequently assessed in studies, alone or together as part of the ColoDefense panel test—the latter with the greatest performance. mBMP3 may not be an appropriate marker for detecting CRC. A panel of five methylated binding sites of the CTCF gene holds the promise for early-stage specific detection of CRC. CRC screening compliance and accuracy can be enhanced by employing a stool mt-DNA methylation test.

Multimodal circulating tumor DNA (ctDNA) colorectal neoplasia detection assay for asymptomatic and early-stage colorectal cancer (CRC).

3536 Background: To improve average risk CRC screening compliance, additional options are needed, especially options that address patient and provider reported barriers such as time and convenience. LUNAR-2 is a multimodal blood-based colorectal neoplasia detection assay incorporating ctDNA assessment of somatic mutations and tumor derived methylation and fragmentomic patterns, aimed to maximize sensitivity for early stage CRC detection. We evaluated this test in a large patient cohort with newly diagnosed CRC. Methods: Individuals diagnosed with CRC between 2013-2016 consented to provide blood samples prior to surgical resection. Those treated with neoadjuvant chemotherapy were excluded. Isolated plasma samples (median 3mL from EDTA) from 434 individuals were analyzed with LUNAR-2 (Guardant Health, USA) and included in the analysis. Median age at CRC diagnosis was 63 years (range 28 - 89) and 41% were female. Control samples were from 271 age-matched cancer free individuals. “ctDNA detected” and “ctDNA not detected” results were generated by a model trained on a separate sample set (N=614) from both cancer free individuals and those with CRC. Calling threshold was determined based on this held-out set to target 90% specificity. ctDNA results and clinical characteristics were correlated. Results: Overall CRC sensitivity was 91% (393/434), with high sensitivity across all stages; 88% Stage I/II, 93% Stage III (Table). Specificity was 94% (255/271). There was no difference in sensitivity when excluding those with early (&lt;45 years) or late (&gt;84 years) onset CRC (90% sensitivity; 388/429; p=0.95; 88% Stage I/II, 93% Stage III). There were no differences in sensitivity for asymptomatic CRC (88%) compared to symptomatic CRC (91%; p=0.4; Table). However, higher cell-free DNA tumor fractions were observed in the symptomatic cohort. Sensitivity for detection of right-sided and left-sided CRC was similar (93% vs. 90%; p=0.5; Table). Conclusions: In this large early-stage CRC cohort, multimodal ctDNA assessment has high sensitivity for CRC detection with high specificity. Equivalent sensitivity in the asymptomatic cohort suggests this test will have clinically meaningful performance in an average risk screening population. A prospective registrational study is ongoing to evaluate the test in an average risk CRC screening cohort.[Table: see text]

S3109 Improving Colorectal Cancer Screening Compliance With Resident Education

INTRODUCTION: The incidence of CRC continues to increase at a rate of 2 1% per year in both men and women Screening for CRC improves prognosis by identifying early-stages for treatment, resulting in lower mortality Compliance rates for CRC screening have been low, and in optimized clinical settings, range from 50% to 70% Fecal Immunochemical Test (FIT) has advantages over colonoscopy as it does not require bowel preparation and anesthesia, and is an easier test to complete We hypothesize that CRC screening rates at our academic community hospital-affiliated clinic will improve by increasing resident education about FIT METHODS: We reviewed the charts of patients aged 50-75 seen by resident physicians at our clinic from June 1, 2019 to December 31, 2019 Patients who did not have a follow-up or comprehensive visit within the mentioned timeframe, had an active diagnosis of CRC or history of colorectal surgery, or with risk factors placing them at high lifetime risk for CRC were excluded Variables included patient age, gender, ethnicity, colonoscopy referral, FIT order, and reasons why CRC screening was not offered Resident physicians were given an educational presentation and an informational e-mail addressing self-reported barriers to ordering FIT for patients We then conducted a post-intervention chart review of patients aged 50-75 evaluated by residents from January 1, 2020 to March 31, 2020 and assessed the association of each variable with multivariate logistic regression RESULTS: There was no significant difference in age, gender, ethnicity and overall CRC screening rates between the pre- and post-intervention groups (Figure 1 ) There was a significant increase in FIT testing over colonoscopy (P=0 012, OR=2 10, 95% CI: 1 104-3 999) and in CRC screening rates in unscreened patients post-intervention (P=0 037, OR=1 55, 95% CI: 0 960-2 501) (Figure 2 ) There was a significant reduction in amount of resident physicians forgetting to screen patients (P=0 003, OR=4 44, 95% CI: 1 664-11 82) (Figure 3 ) CONCLUSION: Education improved the utilization of FIT testing over colonoscopy as well as the overall CRC screening rates in previously unscreened patients at our outpatient clinic Recent EHR data showed a decrease of approximately 86% in CRC screenings across the U S - presumably due to access disruptions due to COVID-19 However, our clinic after resident education shifted towards theutilization of FIT, and ultimately increasing our CRC screening rates for previously unscreened patients (Figure Presented)

Abstract 2354: Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania

Abstract Background: Colorectal cancer (CRC) is a leading cause of mortality in the US. There are racial and socioeconomic disparities in CRC incidence and mortality, in part due to underuse of CRC screening. The goal of this cross-sectional study was to examine multilevel factors associated with CRC screening in Southeastern PA. Methods: We conducted a cross-sectional study using the Public Health Management Corporation's Community Health Database household survey (2010-2015) and American Community Survey data (2010-2014) to examine multilevel factors related to CRC screening via sigmoidoscopy and colonoscopy. We compared adults age 50+ that received CRC screening within 10 years (N=12963) to non-compliant individuals (N=4585), according to American Cancer Society guidelines. We conducted descriptive analyses to compare individual and residential census tract characteristics of the compliant and non-compliant groups. Multilevel regression models including random intercepts for census tracts (CTs) and CT-level socioeconomic status (SES) were used to examine independent associations with CRC screening compliance. P-values &amp;lt;0.05 were considered statistically significant. Results: In bivariate analysis, we observed that individuals that did not comply with CRC screening recommendations were more likely to be younger, male, non-black, unmarried, less educated, uninsured, and current smokers than those in compliance. Non-compliant individuals were also more likely to live in areas with lower SES, shorter distance to public transportation, lower educational attainment, lower median income, and higher percentages of uninsured, unemployed, poverty and households on public assistance compared to those in compliance. In multilevel regression analysis, being unmarried (OR=1.49, 95% CI=1.34-1.65), uninsured (OR=1.65, 95% CI=1.30-2.10), or living in lower SES census tracts (below the first SES quartile: OR=1.48, 95% CI=1.30-1.69 and between the 2nd and 3rd quartile: OR=1.51, 95% CI=1.29-1.75 vs. above the highest quartile) were associated with non-compliance in CRC screening recommendations. There were no interactions detected between race and census tract SES in these models. Conclusions: We identified multilevel factors (marital status, health insurance status, and residential SES) significantly associated with non-compliance to CRC screening recommendations. Individuals and CTs with low levels of compliance can be identified and targeted for tailored interventions, such as peer support and community education about CRC in future studies. Future studies might examine how the availability and location of screening facilities may relate to CRC screening recommendation compliance rates in different neighborhoods. Citation Format: Charnita M. Zeigler-Johnson, Scott Keith, Kari Moore, Russell McIntire, Preethi Selvan, Steven Melly, Ana Diez-Roux. Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2354.

Mo1657 EVALUATION OF SAFETY, USABILITY, AND PATIENT COMPLIANCE USING C-SCAN SYSTEM FOR COLORECTAL CANCER SCREENING: US PILOT STUDY

Current strategies to prevent colorectal cancer (CRC) vary considerably with regard to effectiveness, up-front costs, risks, invasiveness and patient compliance. A known barrier for patients is the cleanse needed for colonoscopy. A non-invassive screening test where structural information could be provided, but not require cleansing of the colon. The C-Scan® capsule-based system is a preparation-free test for CRC screening. The system is based on a low dose radioactive (RA) sealed source embedded in the C-Scan capsule, which radiates X-Rays through a collimator to all directions. The capsule starts scanning in the cecum and the X-ray is emitted when the capsule is passing through. When not moving the capsule is set at an idle mode and the radiation X-ray source is blocked. During the passage of the capsule in the colon, it transmits information to a recorder. The data from the C-Scan Track is then analyzed. The aim of this study was to demonstrate the safety, usability and patient compliance of the C-Scan System (image 1). A multicenter prospective open label single arm study enrolled patients who were eligible for CRC screening. 40 out of 45 patients were included in the study. The five patients not included were unable to swallow the capsule (n=2) or had renal impairment. Mean age was 52.9 ± 5.7 years and 35.8% were male with 85% being Caucasian. No serious adverse events occurred. The most common complaint was self-limiting abdominal cramping from fiber to aid capsule transit. All patients passed the capsule. The mean radiation exposure was 8.4±7.6 (μSv) ,less than a CXR. The mean capsule transit time from ingestion to expulsion was 65.2Hr ± 51.9 Hr. Patient compliance was 100% with all 40 patients that swallowed the capsule. Satisfaction was based on a survey questionnaire using a scoring system 1(strongly disagree) to 5(strongly agree). C-scan was deemed easier than colonoscopy with a score of 4.05 compared to 2.91. C-scan was also more likely be recommended with a score of 4.18 compared 2.86 for colonoscopy. The C-Scan view output data included YES / NO for identification of patients with colon polyps. In 3 patients (10.7% of the analyzed patients), polyps at a size range of 6-9mm were found at colonoscopy. C-Scan identified polyps in 2/3 polyps. Of the 9 patients excluded (data capture failure) from C-scan analysis, 2 had a positive FIT test and polyps >10 mm detected at colonoscopy. To continue to reduce new cases of colon cancer each year, CRC screening compliance is key. Colonoscopy is the gold standard, but patient adherence remains a challenge. In this study, C-Scan demonstrated safety with high patient satisfaction and compliance. Future are planned to improve data capture allowing for increased C-scan analysis and to assess polyp detection in comparison to colonoscopy.

Abstract C109: Colorectal cancer knowledge and screening status among companions of patients undergoing a colonoscopy: An opportunity for a targeted intervention

Abstract PURPOSE: To determine the colorectal cancer (CRC) knowledge, screening compliance, and preference(s) for an intervention to improve screening compliance among companions of patients undergoing colonoscopy. METHODS: Between March and June 2017, we approached individuals who accompanied patients undergoing a colonoscopy (companions) at one of three endoscopy centers to participate in a survey to determine CRC and CRC screening knowledge, attitudes, beliefs, and behaviors. Participants were also asked to provide input about content and format for a future CRC screening intervention. Companions aged 50 to 75 years were eligible to participate. RESULTS: Of the 338 companions approached for participation, 224 (66%) were eligible and completed the survey. Most companions were a spouse or family member (83%), married/living with a partner (78%), female (57%), and had less than a college degree (51%). The sample included companions from a minority race/ethnicity (20%) and those with an annual household income of less than $30,000 (18%). In addition, companions predominantly had health insurance (96%), reported having a personal doctor (88%) and had an evaluation by a healthcare provider within the last year (85%). Among companions at average-risk for CRC (n=166), 38 (23%) were not within screening guidelines and 29 companions reported that they had never completed a screening test. Many companions lacked knowledge about what age to begin CRC screening (85%) and factors associated with increased risk for CRC such as being African American (73%) or male (60%). Among companions not within screening guidelines, the most frequently reported barriers to CRC screening were being asymptomatic (74%) and lack of a provider recommendation (32%). While the majority of companions agreed or strongly agreed that CRC would be serious to their health (99%) and that CRC screening would help protect their health (97%), only 29% of average risk companions not within screening guidelines reported that they intended to undergo CRC screening within the next 6 months. Suggestions for a future CRC screening intervention to be completed by waiting companions included a video shown on a tablet that included men and women from all races/ethnicities, a doctor and nurse, testimonials from individuals who completed CRC screening, and the intervention should last 15 minutes or less. CONCLUSIONS: Given that companions of patients undergoing a colonoscopy wait about two hours for test completion, developing a brief CRC screening intervention for them addresses an overlooked educational opportunity. The brief intervention should address the most commonly reported barriers, the benefits of screening, men and women of different races/ethnicities, doctors and nurses, testimonials from individuals who completed screening, and should activate companions to talk to their doctor about CRC screening. Citation Format: Darrell M Gray II, Menaka Reddy, Abigail Shoben, Paul L Reiter, Mira L Katz. Colorectal cancer knowledge and screening status among companions of patients undergoing a colonoscopy: An opportunity for a targeted intervention [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C109.

Community Assessment of Colorectal Cancer Screening Compliance in Northwest Louisiana.

In the United States, colorectal cancer (CRC) screening rates have steadily increased. The state of Louisiana has persistent lower screening rates compared to the United States and other states, and with African Americans experiencing the highest CRC incidence rates. Aggregate national and state data can be problematic in isolating key health issues and data in rural areas. Study Purpose: At the Louisiana parish-level, which is comparable to county municipalities in other U.S. states, the research study examined endoscopy CRC screening among African American Medicare beneficiaries. Using cluster sampling, survey-based data from two neighboring parishes in northwest Louisiana were collected. The survey instrument was adapted from the Medicare Current Beneficiary Survey. The key study variables were CRC screening compliance, residence location, self-reported CRC knowledge, and physician recommendation. The findings showed significant differences in CRC screening compliance between the two parishes. Participants with CRC knowledge score of at least 3 out of 5 were more likely to be compliant with CRC screening. The findings demonstrated the importance of isolating geo-specific data, especially in rural areas, to plan effective health education or intervention strategies.

2847 Outside the Scope a Better FIT for Some Patients

INTRODUCTION: Colorectal cancer is the 3rd most common cancer in American adults and is the 2nd most common cause of cancer death. Colorectal cancer screening (CRCS) is unique because it not only detects but also prevents cancer from ever developing, something no other cancer screening accomplishes. Despite this advantage, in 2015 the national average for CRCS compliance was only 63%, below the National Colorectal Cancer Roundtable (NCCR) goal of 80%. The reason for the low rate of CRCS is multifactorial including the fear of having a colonoscopy. At the Baylor Scott &amp; White Primary Care Clinic in Round Rock, TX, CRCS compliance in 2019 was 54% for commercial insurance and 73% for Medicare patients. Our goal was to increase our CRCS compliance and provide better preventative care for our patients. METHODS: We reviewed the charts of 200 randomly selected patients who were considered non-compliant with CRCS between September 2017 to September 2018. Non-compliance was defined as a patient who was eligible for CRCS in this one-year time frame but failed to have CRCS. This helped identify causes for why CRCS was not performed. In our review, 0% of these patients were offered alternative methods of CRCS besides colonoscopy. This information led us to educate attending and resident physicians with oral presentations on the availability of alternative testing modalities for CRCS. In addition, one of these modalities, fecal immunochemical test (FIT) kits, were placed in patient rooms in our primary care clinic. Providers were asked to offer patients a colonoscopy for CRCS, and if a patient refused, to then offer FIT testing. RESULTS: Among noncompliant patients, no modalities aside from colonoscopy were mentioned by providers for CRCS to non-compliant patients. With the implementation of FIT kits, patients were more inclined to undergo CRCS. From January to March 2019, there was a 12% CRCS compliance rate. After our intervention in April 2019, CRCS compliance was 18% in April 2019, with the entire 6% increase in compliance coming from FIT test kits. CONCLUSION: Despite its benefit, CRCS remains below compliance goals set by NCCR. By having FIT kits placed in all the clinic rooms, it was more convenient for patients to have CRCS. There will be continued education on the benefits and modalities of CRCS to more health care providers. We plan to implement this project at other Baylor Scott &amp; White Primary Care Clinics in the region.

Patients and Providers Are Amenable to Fecal Immunochemical Testing by Digital Rectal Exam.

Fecal immunochemical testing (FIT) for colorectal cancer (CRC) requires patients to return samples for processing, after having a spontaneously passed stool at home. This results in low completion rates (only 50% in our institution). Using stool obtained during an office-based digital rectal exam (DRE-FIT) could improve compliance, but it is not known whether patients and providers would find this option acceptable. Surveys were given to 100 physicians and 118 patients at our institution. We found that 68% of patients and 88% of providers approved of DRE-FIT making this a potentially effective way to improve CRC screening compliance.

Colorectal Cancer Screening Compliance among Asian and Pacific Islander Americans.

Colorectal cancer (CRC) screening prevalence remains low among Asians and Pacific Islanders. This study examined disparities and predictors of CRC screening compliance in adults age 50-75years in Asians and Pacific Islanders in Hawai'i. Hawai'i Behavioral Risk Factor Surveillance System (BRFSS) data for 2011-2014 were analyzed. CRC screening status was dichotomized. Logistic regression was used to examine ethnic differences in and predictors of CRC screening status. Filipinos (OR 0.56), Chinese (OR 0.70), and Hawaiians (OR 0.75) were significantly less likely than whites to be CRC compliant. Higher education and income, employment, regular health provider, and routine checkups were important predictors of CRC compliance. Findings confirm lower CRC screening compliance in three of the four largest Asian and Pacific Islander groups in Hawai'i and that CRC screening compliance is influenced by several factors. Culturally tailored education and navigation services may be effective in reducing these disparities.

Su1014 - Resource Utilization and Colorectal Cancer Screening Compliance with Patient Navigation in Under-Screened Populations

Su1014 - Resource Utilization and Colorectal Cancer Screening Compliance with Patient Navigation in Under-Screened Populations

Abstract C87: Provider characteristics and timely receipt of cancer screening: The role of communication and race/sex concordance between patients and providers

Abstract Background: Early detection through screening is an important predictor of cancer prognosis and can significantly improve quality of life, lower mortality and reduce treatment costs. Despite improved access, screening remains sub-optimal. Healthcare providers play a crucial role in promoting positive health behaviors by establishing trust through effective patient-provider interactions and communication. It is known that optimal alignment of race/ethnicity and sex between patients and providers as well as satisfaction with interaction with providers may encourage compliance with treatment. It remains unclear if concordance and patient's perceptions of quality of provider's communication influences utilization and adherence to cancer screening. This study's objectives are two-fold:1) To examine if race/ethnicity and sex concordance is associated with compliance for breast, cervical and colorectal cancer screening (CRC) and 2) To estimate the association between patients rating of their provider's communication and receipt of timely screening. Methods: Analyses data are adult respondents with a usual source of care (USC) identified from 2008-2013 Medical Expenditure Panel Survey. Sample sizes varied by services based on U.S. Preventive Services Task Force screening recommendations for breast, cervical and CRC. Concordance was categorized as no concordance, race only, sex only or dual concordance using respondents' report of their own and their providers' race/ethnicity and sex. Perceptions of provider's communication were measured on four dimensions; how often USC 1) asked about prescription medications and treatments from other doctors, 2) showed respect for medical, traditional and alternative treatments that the person wants, 3) involved in making decisions between treatments, 4) presented and explained all options. Separate multivariate logistic regressions were conducted for each cancer screening to examine association with concordance and each communication behavior individually. Results: Women with female providers were more likely to report adherence to mammography [Odds Ratio (OR) = 1.8, 95% confidence interval (CI): 1.3, 2.4; p&amp;lt;0.001] and PAP tests [OR = 1.5, 95% CI: 1.3, 2.0; p=0.006]. Neither sex nor dual concordance was associated with CRC screening. Race concordance alone was not statistically associated with any cancer screening. Women who perceived USC to involve in decision making or asked about treatments from other doctors were more likely to report timely mammograms [OR = 1.2, 95% CI: 1.0, 1.4; p=0.04 and OR = 1.5, 95% CI: 1.2,1.7; p&amp;lt;0.001 respectively] and cervical cancer screening [OR = 1.2, 95% CI: 1.03, 1.4; p=0.02 and OR = 1.3, 95% CI: 1.09,1.6; p=0.005 respectively]. However, only one communication behavior of being asked about treatments was associated with timely CRC screening [OR = 1.2, 95% CI: 1.02, 1.3; p=0.02]. Subgroup analysis indicated that positive perceptions of communication were associated with higher likelihood of reporting all cancer screening among racial and ethnic minorities. Conclusions: Association between sex concordance with breast and cervical cancer screening suggests that either female providers are more likely to recommend them because of better attunement to female preventive needs or patients are more comfortable receiving them from female providers. Results on communication patterns indicate that both measures that were significant, were related to providers' soliciting response from patients which may encourage patient activation and facilitate receipt of cancer screening especially among racial and ethnic minorities. Thus, greater patient involvement and encouraging dialogue with patients can be an important platform for promotion of disease prevention. Healthcare providers play a crucial role in mitigating disparities in cancer screening and should consider interpersonal communication with their patients as an effective instrument to promote timely screening. Note: This abstract was not presented at the conference. Citation Format: Anushree M. Vichare. Provider characteristics and timely receipt of cancer screening: The role of communication and race/sex concordance between patients and providers. [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 C87.

Improving Colorectal Cancer Screening and Surveillance Compliance with a Multidisciplinary Approach in the Outpatient Setting

Introduction: Colorectal cancer (CRC) is a common and preventable malignancy. Studies have shown that removal of premalignant adenomas can prevent cancer and cancer-related deaths. Screening tools have improved the incidence and mortality rates of CRC, along with shifting from late to early stage disease. Therefore, it is important to encourage preventative CRC screening (CRCS) and surveillance by primary care physicians. In this internal medicine outpatient office, compliance rate for CRCS and surveillance was below average at 53% in June 2015. The aim for this project was to develop and implement a tool to improve CRCS and surveillance compliance by 5% within a 12-month time frame among this practice's patients. Methods: We identified barriers to compliance which included lack of health literacy among this patient population, inability to do proper CRCS counseling in a 20-min office visit, and lack of knowledge about fecal immunochemical tests (FIT) as options among medical assistants (MA). We formed a multidisciplinary team of case manager, residents, faculty, and MAs to develop a Plan-Do-Study-Act (PDSA) for performance improvement. We used a quality assessment metrics program called Dashboard to assess compliance. Any patient who was non-compliant in both first and subsequent CRCS were identified. Interventions included educating the MAs on how to use FIT so they are motivated and empowered to provide this to patients, increasing educational information for patients about colonoscopy procedures and offering the option of FIT tests to non-compliant patients, and creating a preventative care form for each visit in order to alert physicians if patients are not up to date on preventative screening. The team met every month to evaluate ongoing progress. Compliance was measured monthly through Dashboard. Results: Since the implementation of the PDSA, compliance for CRCS in the internal medicine outpatient office has continued to improve 1-2% every month. In a 7-month period the compliance rate rose 12% from 53% to 65%. The result of the PDSA accomplished and then surpassed our initial clear aim. Conclusion: The team is continuing to meet on monthly bases to evaluate and modify our metrics to further improve our compliance rate. The implementation of the PDSA with the resulting rapid improvement demonstrates how a multidisciplinary approach for preventative care can improve patients' compliance for CRCS. We hope that this plan can be extrapolated to other gaps in preventative healthcare.Figure 1